Neoadjuvant endocrine therapy for luminal breast cancer treatment: a first-choice alternative in times of crisis, such as the COVID-19 pandemic

Abstract

The epidemiological emergency caused by has changed priorities in breast cancer management. In those places where the pandemic has had the greatest effect, it is of paramount importance for most patients to be at home, reducing or postponing their attendance at clinics, as well as avoiding surgeries. In this scenario, neoadjuvant endocrine treatment could be an appropriate alternative treatment for hormone receptor positive breast cancer (luminal-like tumours) in order to minimise hospital admissions and to delay elective surgeries. Accordingly, we present a simple protocol that can be applied to most cases of luminal-like breast cancer and is appropriate for the majority of secondary or tertiary medical centres, or even primary care.

Management of early breast cancer during the COVID-19 pandemic in Brazil

“…Cancer patients are at an increased risk of contagion, infection, morbidity and death [9][10][11]. Emergency guidelines for breast cancer treatment [13][14][15]32,33] have suggested postponing surgery when the risk of progression is low (luminal tumors), initiating NET, extending the application of NACT and/or target therapies to subtypes of adverse biology (TN and HER2), minimizing the extent of surgery, including avoiding the use of autologous tissue in breast reconstruction, and postponing prophylactic surgery.…”

“…The pandemic and the emergency recommendations for EBC treatment impacted on the management strategies of Brazilian breast specialists. According to these recommendations [13][14][15]24,32,33], HRpositive EBC should preferentially be treated using NET. Some societies have suggested that recommendations for the treatment of EBC should be classi ed by degree of priority according to the advice provided in the Ontario Health Pandemic Planning Clinical Guideline for Patients with Cancer [37], with cases of luminal tumors being classi ed as Priority B and surgery being postponed for 3-6 months.…”

“…Consequently, expert groups have drawn up novel protocols [12][13][14]. The treatment of EBC with a low risk of progression such as ductal carcinoma in situ or invasive hormone-positive tumors could begin, for example, with neoadjuvant endocrine therapy (NET) during the pandemic [15], with surgery being postponed with no negative effect on disease outcome [16][17][18]. Other suggestions include extending the use of neoadjuvant chemotherapy (NACT) to tumors of adverse biology, using strategies to minimize immunosuppression [19][20], and avoiding major or prophylactic surgeries.…”

A tripartite approach can seek to optimize breast cancer management during a pandemic – Real‐Time experience of a developing breast oncology unit in Singapore

“…Triage recommendations estimate the risk of delay‐related outcome compromise. Interventions span deferment, simplification, reorganization of treatment sequence, 7 to pure neo‐adjuvant endocrine therapy in centers with substantial constraints 8 . However, treatment delay can still result in disease upstage, limit surgical options, intensify neo‐adjuvant and adjuvant treatment, and decrease survival 9 .…”

Management of early breast cancer during the COVID-19 pandemic in Brazil

“…Expert groups have drawn up novel protocols for EBC during the pandemic [ 12 – 14 ]. The treatment of EBC with a low risk of progression, such as ductal carcinoma in situ or invasive hormone-positive tumors, could begin, for example, with neoadjuvant endocrine therapy (NET) [ 15 ]. Surgery would then be postponed with no negative effect on disease outcome [ 16 – 18 ].…”