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The use of neoadjuvant endocrine therapy (NET) increased significantly during the first 8 months of the COVID-19 pandemic in women with estrogens positive receptor (ER +) Lung cancer. These patients would normally undergo surgery first, but due to operating room restrictions, these surgeries were delayed due to the pandemic, a new study concludes.
“We hypothesized that by offering non-toxic therapy, we could‘ retain ’patients until the supplies of personal protective equipment were renewed and we could enter the operating room,” said the author, Lee Wilke, MD , Professor of Surgery, Said in the School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin Medscape Medical News.
“And although a small number of women with ER + tumors have NET anyway, we found that more than a third of ER + breast cancer patients were treated with NET due to COVID-19 during the early 8 months from last year, ”he said.
“A year later, 31% of the same patient population still has NET,” he added.
The study was presented during the annual online meeting of the American Society of Breast Surgeons (ASBrS).
COVID specific registration
Willke believes this study presents an accurate snapshot of treatment changes caused by the pandemic.
For the study, the team compared the data collected in the ASBrS mastering program record with the data collected in an embedded but separate COVID segment. The data correspond to the period from March 1 to October 28, 2020.
Nearly three-quarters of the surgeons who admitted patients to the COVID segment were from urban areas; 95% reported stopping mammographic screening during part of this period.
Preliminary analysis focused on data collected from 2476 patients in the COVID segment and 2303 patients in the Mastery registry.
For patients with ER + /HER2- breast cancer, NET was described as a common approach in 6.5% of patients on the COVID-19 registry. In the Mastery registry, 7.8% of patients received NET.
Compared to the first usual surgery / practice, which served as a reference, older patients were more likely to receive NET first due to the COVID-19 pandemic than younger patients, and were more likely to receive NET first if they lived in the northeast or southeast compared to other regions of the United States. Wilke noted that the northeast and southeast were the hardest hit by COVID-19 at the start of the pandemic.
Genomic testing was performed in a small subgroup of patients; The researchers noted that 24% of these patients underwent testing on the primary biopsy specimen due to COVID-19. Genomic testing on a basic biopsy sample helps determine if it is feasible to give up chemotherapy and use NET instead or whether the patient should proceed directly to surgery. The authors note that almost 11% of patients needed a change in the usual surgical approach due to COVID-19. These changes were made primarily to prevent hospitalizations during the initial phase of the pandemic for patients who had to suffer. mastectomy or reconstruction.
“Patients who needed standard approaches still had them,” Wilke emphasized in a statement. For example, women with triple-negative aggressive tumors and HER2 + were treated with neoadjuvant chemotherapy, she added. “However, NET is a very good approach for a moderate subset of patients and we believe we will now use it more frequently in the US,” Wilke noted.
“But, especially in the early days of the pandemic, these revised treatments were necessary because access to hospital ORs was limited or unavailable, so our algorithm-based treatment guidelines allowed us to provide care. high quality evidence-based refined for a cancer-specific patient profile, ”he stated.
Wilke has not disclosed any relevant financial relationship.
22nd ASBrS Annual Meeting. Filed April 29, 2021