A new approach to better select breast cancer patients in need of urgent surgery or chemotherapy during the COVID-19 pandemic has been developed by researchers at The Royal Marsden and the Breast Cancer Now Research Centre at The Institute of Cancer Research, London, in collaboration with colleagues in the U.K., Germany, and the U.S.
The innovative algorithm, using data from multiple international trials, can identify postmenopausal patients with primary ER+HER2- breast cancer (c.70% of cases) who have less endocrine-sensitive tumours and who should be prioritised for early surgery or neoadjuvant chemotherapy.
The COVID-19 pandemic has led to an international need to prioritize the number of cancer surgeries and chemotherapy treatments to the most urgent patients to protect staff and vulnerable patients. While patients diagnosed with triple negative and HER2-positive breast cancer have still been going forward for urgent surgery or chemotherapy, for a large group of patients deferring these treatments and prescribing neoadjuvant endocrine therapy, i.e. treatment to reduce the stimulation of the disease by estrogen without the surgical removal of the breast tumor, has been identified as the best course of treatment.
Development of the new treatment algorithm was led in the UK by researchers working in the Ralph Lauren Centre for Breast Cancer Research at The Royal Marsden and the Breast Cancer Now Toby Robins Research Centre at The Institute of Cancer Research.
Prof. Mitch Dowsett, head of the Ralph Lauren Centre for Breast Cancer Research at The Royal Marsden and Professor of Biochemical Endocrinology at the ICR, led the collaboration published in NPJ Breast Cancer this week. The work highlighted that while 85% of patients in whom treatment by surgery is deferred would be safe to remain on NeoET treatment for up to six months, 15% can be identified who are resistant to this treatment and risk disease spread.
“NeoET can block the tumor from growing successfully for many women but for one in six who are resistant there is a risk the tumor will continue to grow and spread elsewhere,” Dowsett said in a statement.
“By accessing unpublished results from clinical trials involving thousands of patients, with colleagues here and abroad we have developed a new way of directing patients’ treatment in this global crisis. Using the data on estrogen receptor, progesterone receptor and proliferation from the tumor of newly diagnosed patients, our simple new calculator can be used by fellow clinicians worldwide to immediately identify the best course of treatment for about 80% of their patients.
“Then, by drawing upon our earlier research, we can help the other 20% by measuring Ki67 (a protein that measures the number of cells dividing in the tumor) a few weeks after starting their NeoET. Overall, we can identify the 15% of the women who are most at risk of relapsing on just NeoET treatment and should be prioritised for surgery or neoadjuvant chemotherapy.
