Neoadjuvant endocrine therapy use in early stage breast cancer during the covid-19 pandemic

Abstract

Purpose Physician treatment preferences for early stage, estrogen positive breast cancer (ER + BC) patients were evaluated during the initial surge of the COVID-19 pandemic in the US when neoadjuvant endocrine therapy (NET) was recommended to allow safe deferral of surgery. Methods A validated electronic survey was administered May–June, 2020 to US medical oncologists (MO), radiation oncologists (RO), and surgeons (SO) involved in clinical trials organizations. Questions on NET use included practice patterns for locoregional management following NET. Results 114 Physicians from 29 states completed the survey—42 (37%) MO, 14 (12%) RO, and 58 (51%) SO. Before COVID-19, most used NET ‘rarely’ (49/107, 46%) or ‘sometimes’ (36, 33%) for ER + BC. 46% would delay surgery 2 months without NET. The preferred NET regimen was tamoxifen for premenopausal and aromatase inhibitor for postmenopausal women. 53% planned short term NET until surgery could proceed. Most recommended omitting axillary lymph node dissection (ALND) for one micrometastatic node after 1, 2, or 3 months of NET (1 month, N = 56/93, 60%; 2 months, N = 54/92, 59%; 3 months, N = 48/90, 53%). With longer duration of NET, omission of ALND decreased, regardless of years in practice, percent of practice in BC, practice type, participation in multidisciplinary tumor board, or number of regional COVID-19 cases. Conclusion More physicians preferred NET for ER + BC during the pandemic, compared with pre-pandemic times. As the duration of NET extended, more providers favored ALND in low volume metastatic axillary disease. The Covid-19 pandemic affected practice of ER + BC; it remains to be seen how this may impact outcomes. Supplementary Information The online version contains supplementary material available at 10.1007/s10549-021-06153-3.

Are sex hormones promising candidates to explain sex disparities in the COVID-19 pandemic?

“…A special attention should be posed towards men and women under hormonal therapy for prostate and mammary cancer, a therapy that most physician preferred during the pandemic to allow safe deferral of surgery [84].…”

Analysis of the Impact of the COVID-19 Pandemic on the Multidisciplinary Management of Breast Cancer: Review from the American Society of Breast Surgeons COVID-19 and Mastery Registries

“… 20 In a June 2020 survey of US-based oncologic providers, 12% (13) of providers reported that they routinely used NET pre-COVID-19, while a reported 53% (114) of providers reported they would use short-term NET pre-surgically during COVID-19. 21 Another provider survey by the European Breast Cancer Research Association reported that 68% (255) of physicians recommended endocrine therapy for luminal A tumors to enable surgery to be postponed during the pandemic. 22 In randomized trials, NET has been shown to be safe and effective in increasing the rates of breast-conservation therapy.…”

ASO Authors Reflection: Lessons Learned from the COVID-19 Pandemic—Should We Change Surgical Management of Patients with Breast Cancer?

“…This treatment approach permitted delays in surgical resection until additional personal protective equipment (PPE) and other resources could be obtained and specific COVID-19 hospital protocols implemented. 1 Genomic testing on core biopsy specimens versus surgical specimens was also utilized to determine which patients were more suitable for neoadjuvant chemotherapy (NCT) or NET. Telemedicine allowed a pathway where the doctor–patient encounter could occur without additional COVID-19 risks, but could it be successfully implemented with a new breast cancer diagnosis?…”