8 June 2020

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 UK, Germany and US.

The innovative algorithm, using data from multiple international trials, can identify postmenopausal patients with ER positive, HER2 negative primary breast cancer (c.70% of cases) whose cancers are less likely to respond to hormone therapy and who should be prioritised for early surgery or neoadjuvant chemotherapy.

The COVID-19 pandemic has led to an international need to reassess the benefits and risks of cancer treatment approaches and to prioritise surgeries and chemotherapy treatments to patients in most urgent need in order to protect staff and patients who may be more vulnerable to infection.

While patients diagnosed with triple negative or HER2 positive breast cancers have still been going forward for urgent surgery or chemotherapy, for a large group of patients with ER positive breast cancer, deferring these treatments and prescribing neoadjuvant hormone therapy to keep the disease under control and delay their surgery has been identified as the best course of treatment.

The guidelines stratify patients into three groups based on oestrogen and progesterone receptor levels in tumours at diagnosis. The guidelines will immediately help to identify approximately 60% of women whose tumours have high levels of oestrogen and progesterone receptors and can receive hormone therapy for up to six months. Those with lower levels (expected to be around 5% of women) should either be offered urgent surgery or chemotherapy instead.

For the remaining 35%, it is recommended that they begin neoadjuvant hormone therapy and an additional measure of how many cancer cells are actively multiplying in a tumour, called Ki67, should be taken after a few weeks to determine the best course of treatment. If they have low levels of Ki67, they would be recommended to continue on hormone therapy for at least six months, but the guidance recommends that those with higher levels should be considered for surgery or neoadjuvant chemotherapy.

Baroness Delyth Morgan, Chief Executive at Breast Cancer Now, which helped fund the research, said:

“It’s fantastic that this approach could help guide the best possible treatment for thousands of NHS breast cancer patients during the pandemic, and could also now help inform best practice globally.

“This landmark guidance could now help to identify women that must be prioritised for surgery or chemotherapy urgently, and those that could safely be given hormone therapy to delay further treatment during the pandemic. It is a real testament not only to UK science but to the rapid collaboration of researchers globally to help ensure breast cancer patients can get the best possible care while minimising the risks to them at this time.

“Crucially, access to testing for Ki67 or imaging will now be needed to help determine whether some women should continue neoadjuvant hormone therapy for longer, or should be given chemotherapy or surgery. We hope that patients needing these services can be given access to them to ensure they can receive the best treatment for them.

“With some cancer treatments being delayed or changed due to the risks of coronavirus or NHS pressures, we need to do all we can to support patients, doctors and multidisciplinary teams to ensure the right choice for each person. Anyone worried about the impact of the outbreak on their breast cancer treatment can call our free Helpline on 0808 800 6000.”