Abstract PS12-26: “Bridge” neoadjuvant endocrine therapy for early stage breast cancer patients during COVID-19 at an academic hospital in NYC: Lessons learned
Authors: Cen Cindy , Schnabel Freya , Adams Sylvia , Plasilova Magdalena , Yeh Janet , Meyers Marleen , Speyer James , Belenkov Elliot , Kwa Maryann , Novik Yelena , Katz Elena , Guth Amber 
Published: February 2021

Abstract
Background: Neoadjuvant endocrine therapy has traditionally been considered a treatment option for locally advanced and/or surgically high-risk women with hormone positive disease. Early stage hormone-positive breast cancer, on the other hand, is usually managed with upfront surgery, with post-operative hormone therapy as a risk-reducing adjunct. During the COVID-19 pandemic, however, widespread closures of operating rooms throughout the country resulted in many breast cancer patients being offered presurgical endocrine therapy as a bridge to surgery. We explored the demographic and clinicopathologic characteristics of these patients and quantified their rate of uptake. Methods: The Institutional Breast Cancer Database was queried for all patients who were diagnosed with ER+ stage 0, I, or II breast cancer and were offered presurgical endocrine therapy (tamoxifen or aromatase inhibitor) by a medical oncologist from 3/12/2020 to 4/30/2020. Variables of interest included demographics, tumor characteristics, and rate of medication uptake and compliance. Results: Of 192 newly diagnosed breast cancer patients seen at NYU Perlmutter Cancer Center during this time period, 136 patients had early stage ER+ breast cancer. Forty-five patients had not yet undergone surgery, and were recommended to receive presurgical hormonal therapy as a bridge given the COVID-19 pandemic (Table 1). The average age was 60.5 years old (SD=13.8 years, range 31-89), and all were female. Thirty-four of 44 patients were post-menopausal (75.6%), while 10 were premenopausal (22.2%), and one was perimenopausal (2.2%). Twenty-six patients were white (57.8%), 12 were black (26.7%) 3 were Asian (6.7%), and 4 were other (8.9%). Thirty-four patients (75.6%) had invasive disease, while 8 had ductal carcinoma in situ (DCIS, 17.8%), and 3 had DCIS with microinvasion (6.7%). Nine patients (20%) did not take the medication for various reasons: 1 contracted COVID-19, 1 refused any treatment, 1 decided to transfer care out of state, 1 preferred to take a homeopathic remedy instead of endocrine therapy, 1 preferred to wait for surgery without medication, and 4 were scheduled for surgery sooner than anticipated and did not start the medication. The remaining 36 patients (80%) took medication for an average of 43.6 days (SD=27.3 days, range 9-101 days) prior to surgery. Twenty-eight patients (77.8%) took an aromatase inhibitor, and 8 (22.2%) took tamoxifen. Forty-two patients have now undergone surgery (93.3%); the remainder include the patient who is refusing all treatment, the patient who transferred out of state, and one patient who has not yet scheduled surgery, but is reportedly still taking an aromatase inhibitor. Conclusion: Improving adherence to long-term adjuvant endocrine therapy is an urgent need as patient acceptance is low. Reported completion rates range around 50%, and have not been improved by educational or technology-based interventions. The unique situation posed by the current COVID-19 pandemic has temporarily changed the management of early-stage breast cancer, and resulted in a high initial acceptance of endocrine therapy (80%), although duration is shorter in this presurgical setting. Further investigations will evaluate length of use, the psychosocial and behavioral factors that influence willingness to take endocrine therapy, and apply these lessons to management of early-stage hormone-positive breast cancer.
Patient Demographics and Tumor CharacteristicsVariablesTotal (N=45)%Median Age (years)60.5 (31-89)RaceWhite2657.8Black1226.7Asian36.7Other48.9Menopause StatusPre-menopausal1022.2Peri-menopausal12.2Post-menopausal3475.6Mean BMI (kg/m2)28.3 (17.8-46.5)PalpabilityNon-palpable3066.7Palpable1533.3Mammographic Breast DensityEntirely Fatty24.4Scattered Fibroglandular1737.8Heterogeneously Dense2453.3Extremely Dense24.4HistologyDCIS817.8DCIS with microinvasion36.7Invasive carcinoma3475.6Clinical Stage0817.8I2760II1022.2Endocrine Therapy(N=36)Tamoxifen822.2Aromatase Inhibitor2877.8Mean Duration of Endocrine Therapy (days)43.6 (9-101)
Citation Format: Cindy Cen, Freya Schnabel, Sylvia Adams, Magdalena Plasilova, Janet Yeh, Marleen Meyers, James Speyer, Elliot Belenkov, Maryann Kwa, Yelena Novik, Elena Katz, Amber Guth. “Bridge” neoadjuvant endocrine therapy for early stage breast cancer patients during COVID-19 at an academic hospital in NYC: Lessons learned [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS12-26.