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Evidence-based guidelines for managing patients with primary ER+ HER2− breast cancer deferred from surgery due to the COVID-19 pandemic

Many patients with ER+ HER2− primary breast cancer are being deferred from surgery to neoadjuvant endocrine therapy (NeoET) during the COVID-19 pandemic. We have collated data from multiple international trials of presurgical endocrine therapy in order to provide guidance on the identification of pa...

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Autores principales: Dowsett, Mitch, Ellis, Matthew J., Dixon, J. Michael, Gluz, Oleg, Robertson, John, Kates, Ronald, Suman, Vera J., Turnbull, Arran K., Nitz, Ulrike, Christgen, Matthias, Kreipe, Hans, Kuemmel, Sherko, Bliss, Judith M., Barry, Peter, Johnston, Stephen R., Jacobs, Samuel A., Ma, Cynthia X., Smith, Ian E., Harbeck, Nadia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7280290/
https://www.ncbi.nlm.nih.gov/pubmed/32550266
http://dx.doi.org/10.1038/s41523-020-0168-9
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author Dowsett, Mitch
Ellis, Matthew J.
Dixon, J. Michael
Gluz, Oleg
Robertson, John
Kates, Ronald
Suman, Vera J.
Turnbull, Arran K.
Nitz, Ulrike
Christgen, Matthias
Kreipe, Hans
Kuemmel, Sherko
Bliss, Judith M.
Barry, Peter
Johnston, Stephen R.
Jacobs, Samuel A.
Ma, Cynthia X.
Smith, Ian E.
Harbeck, Nadia
author_facet Dowsett, Mitch
Ellis, Matthew J.
Dixon, J. Michael
Gluz, Oleg
Robertson, John
Kates, Ronald
Suman, Vera J.
Turnbull, Arran K.
Nitz, Ulrike
Christgen, Matthias
Kreipe, Hans
Kuemmel, Sherko
Bliss, Judith M.
Barry, Peter
Johnston, Stephen R.
Jacobs, Samuel A.
Ma, Cynthia X.
Smith, Ian E.
Harbeck, Nadia
author_sort Dowsett, Mitch
collection PubMed
description Many patients with ER+ HER2− primary breast cancer are being deferred from surgery to neoadjuvant endocrine therapy (NeoET) during the COVID-19 pandemic. We have collated data from multiple international trials of presurgical endocrine therapy in order to provide guidance on the identification of patients who may have insufficiently endocrine-sensitive tumors and should be prioritised for early surgery or neoadjuvant chemotherapy rather than NeoET during or in the aftermath of the COVID-19 pandemic for safety or when surgical activity needs to be prioritized. For postmenopausal patients, our data provide strong support for the use of ER and PgR status at diagnosis for triaging of patients into three groups in which (taking into account clinical factors): (i) NeoET is likely to be inappropriate (Allred ER <6 or ER 6 and PgR <6) (ii) a biopsy for Ki67 analysis (on-treatment Ki67) could be considered after 2–4 weeks of NeoET (a: ER 7 or 8 and PgR <6 or b: ER 6 or 7 and PgR ≥6) or (iii) NeoET is an acceptable course of action (ER 8 and PgR ≥6). Cut-offs for percentage of cells positive are also given. For group (ii), a high early on-treatment level of Ki67 (>10%) indicates a higher priority for early surgery. Too few data were available for premenopausal patients to provide a similar treatment algorithm. These guidelines should be helpful for managing patients with early ER+ HER2− breast cancer during and in the aftermath of the COVID-19 crisis.
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spelling pubmed-72802902020-06-16 Evidence-based guidelines for managing patients with primary ER+ HER2− breast cancer deferred from surgery due to the COVID-19 pandemic Dowsett, Mitch Ellis, Matthew J. Dixon, J. Michael Gluz, Oleg Robertson, John Kates, Ronald Suman, Vera J. Turnbull, Arran K. Nitz, Ulrike Christgen, Matthias Kreipe, Hans Kuemmel, Sherko Bliss, Judith M. Barry, Peter Johnston, Stephen R. Jacobs, Samuel A. Ma, Cynthia X. Smith, Ian E. Harbeck, Nadia NPJ Breast Cancer Article Many patients with ER+ HER2− primary breast cancer are being deferred from surgery to neoadjuvant endocrine therapy (NeoET) during the COVID-19 pandemic. We have collated data from multiple international trials of presurgical endocrine therapy in order to provide guidance on the identification of patients who may have insufficiently endocrine-sensitive tumors and should be prioritised for early surgery or neoadjuvant chemotherapy rather than NeoET during or in the aftermath of the COVID-19 pandemic for safety or when surgical activity needs to be prioritized. For postmenopausal patients, our data provide strong support for the use of ER and PgR status at diagnosis for triaging of patients into three groups in which (taking into account clinical factors): (i) NeoET is likely to be inappropriate (Allred ER <6 or ER 6 and PgR <6) (ii) a biopsy for Ki67 analysis (on-treatment Ki67) could be considered after 2–4 weeks of NeoET (a: ER 7 or 8 and PgR <6 or b: ER 6 or 7 and PgR ≥6) or (iii) NeoET is an acceptable course of action (ER 8 and PgR ≥6). Cut-offs for percentage of cells positive are also given. For group (ii), a high early on-treatment level of Ki67 (>10%) indicates a higher priority for early surgery. Too few data were available for premenopausal patients to provide a similar treatment algorithm. These guidelines should be helpful for managing patients with early ER+ HER2− breast cancer during and in the aftermath of the COVID-19 crisis. Nature Publishing Group UK 2020-06-08 /pmc/articles/PMC7280290/ /pubmed/32550266 http://dx.doi.org/10.1038/s41523-020-0168-9 Text en © The Author(s) 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.
spellingShingle Article
Dowsett, Mitch
Ellis, Matthew J.
Dixon, J. Michael
Gluz, Oleg
Robertson, John
Kates, Ronald
Suman, Vera J.
Turnbull, Arran K.
Nitz, Ulrike
Christgen, Matthias
Kreipe, Hans
Kuemmel, Sherko
Bliss, Judith M.
Barry, Peter
Johnston, Stephen R.
Jacobs, Samuel A.
Ma, Cynthia X.
Smith, Ian E.
Harbeck, Nadia
Evidence-based guidelines for managing patients with primary ER+ HER2− breast cancer deferred from surgery due to the COVID-19 pandemic
title Evidence-based guidelines for managing patients with primary ER+ HER2− breast cancer deferred from surgery due to the COVID-19 pandemic
title_full Evidence-based guidelines for managing patients with primary ER+ HER2− breast cancer deferred from surgery due to the COVID-19 pandemic
title_fullStr Evidence-based guidelines for managing patients with primary ER+ HER2− breast cancer deferred from surgery due to the COVID-19 pandemic
title_full_unstemmed Evidence-based guidelines for managing patients with primary ER+ HER2− breast cancer deferred from surgery due to the COVID-19 pandemic
title_short Evidence-based guidelines for managing patients with primary ER+ HER2− breast cancer deferred from surgery due to the COVID-19 pandemic
title_sort evidence-based guidelines for managing patients with primary er+ her2− breast cancer deferred from surgery due to the covid-19 pandemic
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7280290/
https://www.ncbi.nlm.nih.gov/pubmed/32550266
http://dx.doi.org/10.1038/s41523-020-0168-9
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