Abstract
The COVID-19 pandemic has required new treatment paradigms to limit exposures and optimize hospital resources, including the use of neoadjuvant endocrine therapy (NAET) as bridging therapy for HR+/HER2-invasive tumors and DCIS. While this approach has been used in locally advanced disease, it is unclear how it may affect outcomes in resectable HR+/HER2- tumors. Women ≥18years diagnosed with in situ (Tis) or non-metastatic HR+/HER2- breast cancer from March-May 2019 and 2020 were included. Fisher's exact test and two-sample t test were used to compare baseline characteristics and surgical outcomes between strata. Sub-analysis was performed between patients who received primary surgery vs a bridging NAET approach. Despite similar clinical characteristics, patients in 2019 were more likely to have a surgery-first approach (75% vs 42%, P-value = .0007), receive surgery sooner (22 vs 29days, P-value < .001), and within 60days from diagnosis date (100% vs 85%, P-value = .0301). Neoadjuvant endocrine therapy was a more prevalent approach in 2020 (48% vs 7%, P-value < .0001). Rates of clinical to pathologic up-staging remained consistent across primary surgery vs bridging NAET subgroups (P-value = .9253). Pandemic-driven treatment protocols provide a unique opportunity to assess the utility of bridging endocrine therapy for resectable HR+/HER2- tumors. Differences in clinical and pathologic staging were similar across groups and did not appear to be affected by receipt of NAET. Our limited cohort demonstrates this strategic therapeutic avenue can optimize health care utilization and may be a reasonable approach when delaying surgery is preferred.
Highlights
In December 2019, a novel coronavirus, SARS-CoV-2 (COVID-19), was identified in Wuhan, China, and quickly spread globally
Pandemic treatment protocols provide a unique opportunity to assess the safety of bridging endocrine therapy for HR+/HER2- invasive cancer in women with resectable tumors
Women treated with bridging neoadjuvant endocrine therapy did not exhibit higher rates of pathological up-staging when compared to a case-matched population treated under pre-pandemic standard of care guidelines
Summary
In December 2019, a novel coronavirus, SARS-CoV-2 (COVID-19), was identified in Wuhan, China, and quickly spread globally. Organization (WHO) officially declared the outbreak a pandemic and global health emergency.[1,2,3] Due to the immunosuppressive effects of malignancies, surgery, and chemotherapeutic agents, cancer patients were identified as a susceptible patient population to COVID19 with infection resulting in increased morbidity and mortality than the general population.[4] Clinicians were faced with an unseen challenge—balancing the risk of potential COVID-19 infection vs the risk of delayed cancer treatment for their patients. The COVID-19 pandemic has required new treatment paradigms to limit exposures and optimize hospital resources, including the use of neoadjuvant endocrine therapy (NAET) as bridging therapy for HR+/HER2invasive tumors and DCIS. While this approach has been used in locally advanced disease, it is unclear how it may affect outcomes in resectable HR+/HER2- tumors
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