TUESDAY, May 4, 2021 (HealthDay News) — As the COVID-19 pandemic unfolded, breast cancer experts realized space in operating rooms and hospitals may become infrequent. That meant rethinking standard care, to provide the best way to take care of patients under these suddenly restricted conditions.
One of those new ideas: Reverse the order of caution given to patients with a type of breast cancer known as estrogen receptor-positive (ER+). ER+ cancer is a frequent kind of breast cancer and generally has a fantastic outlook.
Instead of having medication called neoadjuvant endocrine therapy (NET) after surgery, as is much more common, patients would receive NET first and surgery later, because ORs were scarce. And because doctors didn’t know how long the postponement in operations might last, they put up a system to monitor what was occurring to girls who influenced by the delays across the United States.
Study leader Dr. Lee Wilke said her staff wanted to”catalog across the country how long did patients get their surgery postponed or their treatment postponed, and what mechanisms did surgeons use to try and make sure that they were still able to treat their patients in an effective manner.” Wilke is professor of surgery at University of Wisconsin School of Medicine and Public Health, in Madison.
The preliminary findings were presented Sunday at an online meeting of the American Society of Breast Surgeons (ASBrS). Research presented at meetings is typically considered preliminary until published in a peer reviewed journal.
Treating cancers in this way was a part of an effort by the breast surgeons’ group and other cancer societies to develop treatment guidelines for times when access to operating rooms is limited.
Doctors also developed a series of options to further evaluate patients, Wilke said. This included testing for gene mutations in a tumor’s DNA to determine which patients needed chemotherapy.
Patients who needed standard approaches still got them, Wilke said. For example, women with aggressive triple negative and HER2+ tumors were still treated with chemotherapy.
Data used in the study came from nearly 4,800 patients listed in the registry starting in March 2020. In all, 172 breast surgeons entered information in the registry.
Due to COVID-19, NET was used to treat an additional 554 patients (36%) who would otherwise have had surgery first between March 1 and Oct. 28, 2020, the study found. Later results through March 2021 put the total at 31%.
NET was also used in 6.5% to 7.8% of patients in the registries who would typically have had this treatment, the study authors said in an ASBrS news release.
The patterns found in the registry are what cancer experts discussed early in the pandemic, said Dr. Tari King, chief of breast surgery at Dana-Farber/Brigham and Women’s Cancer Center in Boston, who was not involved in the study.
“We had good data to confirm this could be a reasonable strategy for nearly all patients coming in with ER+ breast cancer, we can use this as a bridge to surgery without negatively affecting their outcomes,” King said.
Several clinical trials had already validated the approach, which is more common in Europe.
Anti-estrogen endocrine therapy blocks or decreases the ability of hormones to grow certain types of cancer cells. In the United States, it is typically used in postmenopausal women with larger tumors, Wilke said.
The study also found that there were fewer immediate breast reconstruction surgeries because shorter operating times prioritized cancer removal.
About 24% of patients had testing for genetic mutations on biopsied tumor tissue, the study found.
Dana-Farber/Brigham and Women’s Cancer Center was already using core biopsy for these genomic studies to determine which women needed chemotherapy prior to surgery, King said.
In places like Boston, cancer treatment returned to normal in the late fall, she noted.
King said many of the patients who started on preoperative endocrine therapy at the center didn’t stay on the treatment as long as they normally would have if the goal had been to shrink the tumor, because they were already candidates for a lumpectomy.
Though this treatment change was temporary, King said it challenges researchers to think more broadly about which patients may benefit from NET in the future. It shrinks tumors as well as chemo, but it takes longer to do so, she said.
“But certainly neoadjuvant endocrine therapy has far fewer side effects, less toxicity than chemotherapy does,” King said. “I believe it will push us to think about using it more broadly when we’re trying to shrink an ER+ tumor if the individual is not a candidate for chemotherapy.”
Wilke added that it may take three to four years to comprehend the entire impact of the changes stemming from the pandemic. A number of the new protocols may continue.
The American Cancer Society has more about breast cancer.
SOURCES: Lee Wilke, MD, professor, surgery, University of Wisconsin School of Medicine and Public Health, and director, UW Health Breast Center, Madison; Tari King, MD, chief, breast surgery, Dana-Farber/Brigham and Women’s Cancer Center, professor, surgery, Harvard Medical School, and associate chairwoman, multidisciplinary oncology, Brigham and Women’s Hospital, Boston; American Society of Breast Surgeons, yearly meeting, May 2, 2021, online demonstration