PUBLISHED ON: 8 June 2020

Researchers help clinicians select the best possible treatment for women with oestrogen receptor positive breast cancer during the COVID-19 pandemic.

Photograph of test tubes

Analysing data from multiple trials

Leading researchers from the UK, Germany and US, including researchers funded by Breast Cancer Now, proposed a new method to asses which women diagnosed with oestrogen receptor (ER) positive breast cancer during the COVID-19 pandemic need urgent surgery or chemotherapy.

Analysing data from international trials, scientists arrived at guidance that will help doctors to know whose cancer is less likely to respond to hormone therapy.

Researchers highlight that the guidance should be used together with other clinical information, such as tumour characteristics, age and other health conditions, to ensure the right treatment for each person

Responding to urgent need

Due to the COVID-19 pandemic some cancer treatments have been altered to protect patients who may be more vulnerable to the infection.

Some women diagnosed with ER positive breast cancer have been prescribed hormone therapy to keep the disease under control and delay their surgery. But for some, hormone therapy alone may not work well enough.

Professor Mitch Dowsett, who led the study, explained: ‘Neoadjuvant hormone therapy can block the tumour from growing successfully for many women, but for one in six who are resistant there is a risk the tumour will continue to grow and spread elsewhere.’

Investigating yet unpublished results from clinical trials with thousands of patients, researchers developed a set of guidelines that can help doctors distinguish postmenopausal ER positive breast cancers that shouldn’t be treated with hormone therapy in the first instance to delay surgery.

Mitch said: ‘The speed and openness of this collaboration to help our patients as rapidly as possible has been unparalleled in my 30 years’ experience.’

Since breast cancer before the menopause is much less common, researchers didn’t have enough data to suggest similar guidelines for premenopausal women.

Relying on available information

Scientists worked to ensure their guidelines are evidence-based, are easy to follow and can be used immediately. The guidelines rely on looking at the tumours features, such as oestrogen receptor levels and progesterone receptor levels. For most breast cancer patients, this information is available at the time of diagnosis.

Based on oestrogen and progesterone receptor levels in the tumour, the guidelines immediately help identify 60% of women who can receive hormone therapy for up to six months and 5% of women who should either be offered urgent surgery or chemotherapy instead.

Baroness Delyth Morgan, Chief Executive at Breast Cancer Now, 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.’

For the other 35%, an additional measure assessing how many cancer cells are actively multiplying in a tumour, called Ki67, is needed to determine the best course of treatment. This test should be taken after a couple of weeks of hormone therapy.

‘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 these patients can be given necessary priority for these services to ensure they can receive the best treatment for them,’ said Delyth.

Future promise

This approach may also have a role in selecting the most suitable treatment for women with early postmenopausal ER positive breast cancer after the COVID-19 pandemic. But it would need to be further tested before it becomes common practice outside the pandemic.

The study is published in the NPJ Breast Cancer.

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