Bridging pre-surgical endocrine therapy for breast cancer during the COVID-19 pandemic: outcomes from the B-MaP-C study
Authors: Dave Rajiv V. , Elsberger Beatrix , Taxiarchi Vicky P. , Gandhi Ashu , Kirwan Cliona C. , Kim Baek , Camacho Elizabeth M. , Coles Charlotte E. , Copson Ellen , Courtney Alona , Horgan Kieran , Fairbrother Patricia , Holcombe Chris , Kirkham Jamie J. , Leff Daniel R. , McIntosh Stuart A. , O’Connell Rachel , Pardo Ricardo , Potter Shelley , Rattay Tim , Sharma Nisha , Vidya Raghavan , Cutress Ramsey I. ,   B-MaP-C study collaborative, Imran Abbas , Al-Zawi Abdalla Saad Abdalla , Abbas Abeera , Chrysafi Ada , Critchley Adam , Walsh Adam , Hamad Ahmed , Sahu Ajay , Knight Alex , Humphreys Alexandra , Salih Ali , Chambers Alice , Moody Alice , Diab Alsarah , Taylor Amanda , Thorne Amanda , Asour Amani , Agrawal Amit , Goyal Amit , Carmichael Amtul , Sami Amtul , Larentzakis Andreas , Pieri Andrew , Tanhueco Angeline , Hargreaves Anita , Sharma Anita , Satpathy Anjana , Heeney Anna , Hurley Anna R. , Tansley Anne , Piñero-Madrona Antonio , Sandhya Anu , Shrotri Anu , Sharma Anup , Chaudhry Anushka , Gvaramadze Anzors , Ansari Aonghus , Kattakayam Arjun , Hill Arnold D. K. , Adwani Asha , Chouhan Ashok , Kothari Ashutosh , Segaran Ashvina , Ray Atanu , Mirshekar-Syahkal Bahar , Riogi Bahaty , Zeidan Bashar , Elsberger Beatrix , Pereira Bernadette , Hogan Brian , Isgar Brian , Podesta Carl , Courtney Carol-Ann , Mortimer Caroline , Pogson Caroline , Krzyzanowska Catherine , Felício Cátia , Navin Channegowda , Zammit Charles , Ives Charlotte , Kallaway Charlotte , Lobo Cheryl , Williams Chloe , Laban Christiana , Cartlidge Christopher W. J. , Wilson Christopher , McGoldrick Ciara , Hollywood Ciaran , Rutherford Claire Louise , Harding-Mackean Claudia , Simonca Claudiu , Power Colm , Ubayawansa D. H. B. , Elfadl Dalia , Dodwell David , Sibbering David Mark , Rew David , Akolekar Deepika , Hadjiminas Demetrios , Remoundos Dennis , Rana Dheer Singh , Gonçalves Diana , Betal Dibendu , Banerjee Dibyesh , Thekkinkattil Dinesh , Mehta Disha , Egbeare Donna , Dumitru Dorin , Ferguson Douglas , Ravichandran Duraisamy , Rahman E. , Quinn Edel , John Edward R. C. St , Khalifa Eiman , Abdalla El-Rasheed , Borg Elaine , Hyett Elaine , Massey Eleanore J. , Ntakomyti Eleni , Davies Eleri , Kalakouti Eliana , Clayton Elizabeth , Smyth Elizabeth , Barua Ellora , Garreffa Emanuele , de Sousa Emma , MacInnes Emma , Agabiti Ennio , Najeeb Erum , Mallidis Evangelos , Rapisarda Fabio , Pakzad Farrokh , Salem Fathi , Mazari Fayyaz , Alkistawi Firas Eddin Bachir , Kenny Frances , Trollman Frank , MacLean Gael , Irwin Gareth W. , Boundouki George , Oni Georgette , Exarchos Georgios , Karagiannidis Georgios , Gui Gerald , Mitchell Geraldine , Byrne Gerard , Clayton Gillian , Cuffolo Giulio , Mondani Giuseppina , Urquhart Gordon , Knowles Hannah , Devalia Haresh , Khout Hazem , Dent Helen , Sweetland Helen M. , Mathers Helen , Mora Henrique , Cain Henry , Robb Henry Douglas , Fatayer Hiba , Hamed Hisham , Shaker Hudhaifah , Tuffaha Hussein , Shin Hyunjin , Brown Iain , Daltrey Ian , Whitehead Ian , Young Ian , Azmy Iman , Abbas Imran , Peerlink Inga , Athanasiou Irene , Osorio-Silla Irene , Dash Isabella , Bentley James , Cook James , Harvey James , McIntosh Jamie , Vatish Jamie , Aitken Jane , Ooi Jane , Ralph Jane , Turner Jane , Noronha Jarin Louis , Krupa Jaroslaw , Gahir Jasdeep , Gill Jasper , Rusby Jennifer E. , Isherwood Jennifer , Long Jennifer , Peck Jennifer , Banks Jenny , Batt Jeremy , Jibril Jibril , Mondani Jo , Franks Joanna , Seward Joanna , Benson John , Murphy John , Horsnell Jonathan D. , Lund Jonathan , Selmani Jonida , Sanchez-Mendez Jose I. , Maalo Joseph , Henderson Julia , Massey Julia , Doughty Julie , Dunn Julie , Valassiadou Kalliope , Pushdary Kamal , Bosch Karen , James Karen , Cox Karina , Shenton Karyn , McEvoy Kat , Zechmeister Katalin , Lakatosova Katarina , Williams Kate E. , Kirkpatrick Katharine , Fairhurst Katherine , Krupa Katherine , Harborough Kathryn E. , Hogben Katy , Lambert Kelly , Chong Kelvin , Amin Khalid , Asgeirsson Kristjan , Cheung Kwok-Leung , Romics Laszlo , Martin Lee , Lai Lee-Min , Chagla Leena , Whisker Lisa , Kalra Loraine , Cook Lorna , Alder Louise , Merker Louise , Noor Lubna , Jones Lucie , Khan Lucy R. , Prusty Lydia , Highton Lyndsey , Elahi M. Bilal , Hussien Maged , Savage Mairead , Fuller Mairi , Gowda Manoj , Bramley Maria , Callaghan Maria , Vernet-Tomas Maria , Verroiotou Maria , Gomez Marta Jimenez , Cariati Massimiliano , Sarker Masuma , Hague Matthew , Rowland Matthew , Faheem Michael , Allen Michael J. , Mullan Michelle , Shere Mike , Girgis Mina , Youssef Mina M. G. , Sardar Mini V. , Elamass Mohamed , Elkorety Mohamed , Lafi Mohamed , Sait Mohamed Razick , Sharif Mohammad Amir , Absar Mohammed , Dani Mohsin , Sulieman Mona , Kaushik Monika , Salman Muhammad , Barkeji Musa , Chandrashekar Mysore , Nasir Nabila , Touqan Nader , Betambeau Nadine , Coombs Nathan , Johns Neil , Patani Neill , Goh Ngee-Ming , Gallegos Nicholas , Holford Nicholas , Abbott Nick , Barnes Nicola , Laurence Nicola , Roche Nicola , Dimopoulos Nikitas , Michalopoulos Nikolaos V. , Scally Norah , Stanilov Noyko , Bakri Nur Amalina Che , Fafemi Oladapo , Odofin Olubunmi , Kokoropoulos Panagiotis , Roy Pankaj , Forouhi Parto , Thiruchelvam Paul , Trapszo Pawel , McManus Penelope , Barry Peter A. , Liptay-Wagner Peter , Mallon Peter , Charalampoudis Petros , Drew Philip , Turton Philip , Matey Pilar , King Polly , Partlett Polly , Wignarajah Primeera , Ainsworth Rachel , English Rachel Elizabeth , Foster Rachel , Soulsby Rachel , Tillett Rachel , Lee Rachel Xue Ning , Chadha Radhika , Al-Mufti Ragheed , Achuthan Raj , Eid Raja , Burrah Rajaram , Vashisht Rajiv , Nair Rajive , Bunza Ralia , Vinayagam Raman , Tabbakh Rami , Bichoo Raouef Ahmed , Rathinaezhil Rathi , Law Rebekah , Salman Reem , Salvador Reginald , Bonomi Riccardo , Johnson Richard , Sutton Richard , Parmeshwar Rishikesh , Chalmers Ritchie , Rampal Ritika , Hardy Rob , Macmillan Robert , Thomas Robert , Andrés-Luna Rogelio , Jacklin Rosamond , Simson Rosie , Mullen Russell , James Ruth , Athwal Ruvinder , Ramzi Sa’ed , Bezzaa Sabrina , Jafferbhoy Sadaf , Jeffreys Sam , Sloan Samantha A. , Williams Samantha K. , Laali Samir , Shaheed Samy , Joshi Sanjay , Chandrasekharan Sankaran , Narayanan Sankaran , Somasundaram Santosh , Barker Sarah , Horne Sarah , Dua Sascha , Govindarajulu Sasi , Phyu Saung Hnin , Marla Sekhar , Mylvaganam Senthurun , Poonawala Shabbir , Waheed Shamaela , Chopra Sharat , Wallace Sharon , Shokuhi Sheila , Stallard Sheila , Monib Sherif , Mckenzie Shireen , Harries Simon , Hawkins Simon , Marsh Simon , Pain Simon , Pilgrm Simon , Smith Simon , Thomson Simon , Rooney Siobhan , Olsen Sisse , Soumian Soni , Bathla Sonia , Wardle Stacy , Jenkins Stephanie C. , McCulley Stephen , Robertson Stuart , Goyal Sumit , Chatterjee Sumohan , Saha Sunita , Williams-Jones Susan , Gilani Syeda Nadia Shah , Kiernan Tamara , de Silva Tania S. , Sircar Tapan , Gandamihardja Tasha , Sidiropoulos Theodoros A. , Stroud Thomas , Sein Tin Aung , Gathani Toral , Irvine Tracey , Rasheed Tuabin , Jain Urvashi , Suleiman Usama , Andaleeb Uzma , Gopalan Vallipuran , Sakellariou Vasileios , Kantola Venla , Mathen Vinod , Al Sarakbi Wail , Sasi Walid , Sotheran Wendy , Allum William H. , Wahedna Yasmin , Masannat Yazan , Mikhael Youhana , Sabah Yousuf , Al-Ishaq Zaid , Taraki Zarghuna , Rayter Zenon , Tomlins Abigail , Correia Alda , Sharif Amir , Magalhães André , Sathpathy Anjana , Madrona Antonio Piñero , Al-Allak Asma , de Lema Aurea Manso , Zedian Bashar , Kumar Balendra , Smith Brendan , Navin C. , Richardson Caroline , Sekharan Chandra , Constantinou Chloe , Wayte Chris , Summerhayes Christina , Fowler Clare , Murphy Claire , Rogers Colin , Alvarez Covadonga Marti , Macmillan Douglas , Coveney Eamonn , Gutteridge Eleanor , Kleidi Eleftheria , Pineda Elisa York , Osório Fernando , Court Fiona , Kenny Francis , Osborn Gary , Yiasoumis Georgina , Petralia Gloria , Deol Harleen , Hunt Richard , Robertson John , Fougo José Luis , Olivar Lara Miralles , Johnson Laura , Baber Mahwash , Badia Marcel Segura , Ullah M. D. Zaker , Hassanally D. , Dunne Nicola , Connolly Susie , El-Gammal Mohsin , Skelly Brendan , Ahmed Ibrahim , Crane P. W. , Satherley Lucy , Simoes Tracey , Vaithilingam Natarajan , Arkadopoulos Nikolaos , Danias Nikolaos , Argudo Nuria , Macmanus P. , Vassiliu Pantelis , Batalla Pau Nicolau , Auñon Pilar Zamora , Tillett Rachel , Vestey Sarah B. , Tang Sarah , Salido Sergio , Aggarwal Shweta , Pilgrim Simon , Costa Susy , Winters Zoe 
Published: April 2023

Abstract
Purpose
The B-MaP-C study investigated changes to breast cancer care that were necessitated by the COVID-19 pandemic. Here we present a follow-up analysis of those patients commenced on bridging endocrine therapy (BrET), whilst they were awaiting surgery due to reprioritisation of resources.

Methods
This multicentre, multinational cohort study recruited 6045 patients from the UK, Spain and Portugal during the peak pandemic period (Feb–July 2020). Patients on BrET were followed up to investigate the duration of, and response to, BrET. This included changes in tumour size to reflect downstaging potential, and changes in cellular proliferation (Ki67), as a marker of prognosis.

Results
1094 patients were prescribed BrET, over a median period of 53 days (IQR 32–81 days). The majority of patients (95.6%) had strong ER expression (Allred score 7–8/8). Very few patients required expedited surgery, due to lack of response (1.2%) or due to lack of tolerance/compliance (0.8%). There were small reductions in median tumour size after 3 months’ treatment duration; median of 4 mm [IQR − 20, 4]. In a small subset of patients (n = 47), a drop in cellular proliferation (Ki67) occurred in 26 patients (55%), from high (Ki67 ≥ 10%) to low (< 10%), with at least one month’s duration of BrET.

Discussion
This study describes real-world usage of pre-operative endocrine therapy as necessitated by the pandemic. BrET was found to be tolerable and safe. The data support short-term (≤ 3 months) usage of pre-operative endocrine therapy. Longer-term use should be investigated in future trials.