How the pandemic changed the cure for breast cancer

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By Cara Murez

HealthDay Reporter

TUESDAY, MAY 4, 2021 (HealthDay News) – As COVID-19 pandemic deployed, Lung cancer experts realized that space in operating rooms and hospitals could be scarce. This meant rethinking standard care to provide the best way to treat patients in these suddenly restricted conditions.

One of the new ideas: to reverse the order of care given to patients with a type of breast cancer known as estrogens positive receptor (ER +). ER + cancer it 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 receive NET first and surgery later, as ORs were so scarce. And because doctors didn’t know how long the postponement of surgeries could last, they set up a system to keep track of what was happening to women affected by delays in the United States.

The study’s leader, Dr. Lee Wilke, said her team wanted to “catalog across the country how long patients were postponed or postponed treatment and what mechanisms surgeons used to try to make sure that they were still able to deal effectively. ” Wilke is a professor of surgery at the University of Wisconsin School of Medicine and Public Health in Madison.

Preliminary findings were presented Sunday at an online meeting of the American Society of Breast Surgeons (ASBrS). Research presented at meetings is usually considered preliminary until it is published in a peer-reviewed journal.

Treating cancers in this way was part of the effort by the group of breast surgeons and other oncology societies to develop treatment guidelines for times when access to operating rooms is limited.

Doctors also developed a number of options to further assess patients, Wilke said. This included testing for gene mutations in the DNA of a tumor to determine which patients needed it chemotherapy.

Patients who needed standard approaches still had them, Wilke said. For example, women with triple negative and aggressive HER2+ tumors were still treated with chemotherapy.

The data used in the study came from about 4,800 patients enrolled in the registry as of March 2020. In total, 172 breast surgeons entered information into the registry.

Continued

Because of COVID-19, NET was used to treat an additional 554 patients (36%) who would otherwise have been operated on first between March 1 and October 28, 2020, according to the study. Subsequent results up to March 2021 put the total at 31%.

NET was also used in 6.5% to 7.8% of patients on records who would normally have had this treatment, the study authors said in an ASBrS press release.

The patterns on the record are those discussed by cancer experts in the early days of the pandemic, said Dr. Tari King, head of breast surgery at Boston’s Dana-Farber / Brigham and Women’s Cancer Center. participate in the study.

“We had good data to support that this would be a reasonable strategy for most patients with ER + breast cancer, that we could use it 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 commonly used in postmenopausal women with larger tumors, Wilke said.

The study also found that there were fewer immediate breast reconstruction surgeries because shorter operating periods prioritized cancer removal.

Approximately 24% of patients underwent genetic mutation testing in biopsied tumor tissue, according to the study.

Dana-Farber / Brigham and Women’s Cancer Center were already using a basic biopsy for these genomic studies to determine which women needed chemotherapy before surgery, King said.

In places like Boston, cancer treatment returned to normal in the late fall, he noted.

King said many of the patients who began preoperative endocrine therapy at the center did not stay in treatment for as long as they normally would if the goal had been to shrink the tumor, as they were already candidates for a tumorectomy.

Although this change in treatment was temporary, King said it challenges researchers to think more broadly about which patients might benefit from NET in the future. It reduces tumors and chemotherapy, but it takes longer to do so, he said.

Continued

“But without a doubt, neoadjuvant endocrine therapy has far fewer side effects, far less toxicity than chemotherapy,” King said. “I think it pushes us to think about using it more broadly when we try to reduce an ER + tumor if the patient is not a candidate for chemotherapy.”

Wilke added that it can take three to five years to understand the full impact of the changes resulting from the pandemic. Some of the new protocols may continue.

More information

The American Cancer Society has more information Lung cancer.

SOURCES: Lee Wilke, MD, Professor of Surgery, University of Wisconsin School of Medicine and Public Health, and Director, UW Health Breast Center, Madison; Tari King, MD, head of breast surgery, Dana-Farber / Brigham and Women’s Cancer Center, professor, surgery, Harvard Medical School, and associate president of multidisciplinary oncology, Brigham and Women’s Hospital, Boston; American Society of Breast Surgeons, annual meeting, May 2, 2021, online presentation

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