From Cara Murez
HealthDay reporter
TUESDAY, May 4, 2021 (HealthDay News) – As the COVID-19 pandemic spread, breast cancer experts realized that space could become tight in operating rooms and hospitals. This has meant rethinking standard of care in order to provide the best way to treat patients in these suddenly constrained conditions.
One of the new ideas: reverse the order of treating patients with a type of breast cancer known as estrogen receptor positive (ER +). ER + cancer is a common type of breast cancer and generally has a good outlook.
Instead of receiving medication known as neoadjuvant endocrine therapy (NET) after surgery, as is more common, patients would have NET surgery first and surgery later because the surgeries were so infrequent. And because the doctors didn’t know how long the postponement of operations might take, they put in place a system to keep track of what happened to women affected by the delays in the United States.
Head of Studies Dr. Lee Wilke said her team wants to “catalog across the country how long patients have postponed their surgery or treatment and what mechanisms surgeons used to ensure they can still treat their patients.” an effective way. “Wilke is Professor of Surgery in the School of Medicine and Public Health at the University of Wisconsin at Madison.
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The preliminary results were presented at an online meeting of the American Society of Breast Surgeons (ASBrS) on Sunday. Research presented at meetings is generally considered preliminary until published in a peer-reviewed journal.
Treating cancer in this way was 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 number of options to further evaluate patients, Wilke said. This involved 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 continued to receive chemotherapy.
The data used in the study came from nearly 4,800 patients enrolled in the registry as of March 2020. A total of 172 breast surgeons entered information into the registry.
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Due to COVID-19, an additional 554 patients (36%) were treated with NET who would otherwise have been operated on between March 1 and October 28, 2020. Subsequent results through March 2021 are 31%.
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NET was also used in 6.5% to 7.8% of patients in the registries who would normally have received this treatment, the study’s authors said in an ASBrS press release.
The patterns found in the registry are what cancer experts were discussing at the start of the pandemic, said Dr. Tari King, director 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 show that this is a reasonable strategy for the majority of ER + breast cancer patients and that we can use this as a bridge to surgery without negatively affecting their outcomes,” said King.
Several clinical studies had already validated the approach that is widespread in Europe.
Endocrine anti-estrogen therapy blocks or decreases the ability of hormones to produce certain types of cancer cells. In the United States, it’s typically used in postmenopausal women with larger tumors, Wilke said.
The study also found that there were fewer immediate breast reconstruction surgeries as shorter surgery times gave priority to cancer removal.
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About 24% of patients had tests for genetic mutations on biopsied tumor tissue, the study said.
The Dana-Farber / Brigham and Women’s Cancer Center was already using a core biopsy for these genomic studies to determine which women needed chemotherapy before surgery, King said.
In places like Boston, cancer treatment returned to normal by late fall, she noted.
King said that many of the patients who started preoperative endocrine therapy at the center didn’t stay on treatment as long as they normally would if the goal had been to shrink the tumor because they are already candidates for a lumpectomy.
Although this treatment change was temporary, King urged researchers to think more carefully about which patients might benefit from NET in the future. It shrinks tumors as well as chemotherapy, but it takes longer, she said.
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“But certainly neoadjuvant endocrine therapy has far fewer side effects and far less toxicity than chemotherapy,” said King. “I think it makes us think about using it more broadly when trying to shrink an ER + tumor when the patient is otherwise not a candidate for chemotherapy.”
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Wilke added that it could take three to five years to understand the full impact of the changes caused by the pandemic. Some of the new protocols may continue.
More information
The American Cancer Society has more about breast cancer.
SOURCES: Dr. Lee Wilke, professor of surgery in the University of Wisconsin’s School of Medicine and Public Health and director of the UW Health Breast Center in Madison; Tari King, MD, Chief, Breast Surgery, Dana-Farber / Brigham and Women’s Cancer Center, Professor, Surgery, Harvard Medical School, and Vice President, Multidisciplinary Oncology, Brigham and Women’s Hospital, Boston; American Society of Breast Surgeons, annual meeting, May 2, 2021, online presentation
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