?Bridge? neoadjuvant endocrinetherapy for early stage breast cancer patients during COVID-19 at an academic hospital in NYC: Lessonslearned
Authors: L. Malorni, S. Tyekucheva, F. S. Hilbers, M. Ignatiadis, P. Neven, M. Colleoni, S. Henry, A. Ballestrero, A. Bonetti, G. Jerusalem, K. Papadimitriou, A. Bernardo, F. Duhoux, I. MacPherson, A. Thomson, D. Mark Davies, M. Bergqvist, M. Benelli, A. McCartney, H. De Swert, B. Ruepp, M. Rabaglio, R. Maibach, M. Piccart, M. M. Regan
Journal: Cancer Research (2021)

Background: Neoadjuvant endocrine therapy has traditionally been considered a treatment option for locallyadvanced 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 thecountry 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 withER+ 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, tumorcharacteristics, and rate of medication uptake and compliance  Results: Of 192 newly diagnosed breast cancerpatients 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 hormonaltherapy 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 totransfer care out of state, 1 preferred to take a homeopathic remedy instead of endocrine therapy, 1 preferred towait for surgery without medication, and 4 were scheduled for surgery sooner than anticipated and did not start themedication  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 alltreatment, the patient who transferred out of state, and one patient who has not yet scheduled surgery, but isreportedly still taking an aromatase inhibitor  Conclusion: Improving adherence to long-term adjuvant endocrinetherapy is an urgent need as patient acceptance is low  Reported completion rates range around 50%, and have notbeen 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 initialacceptance of endocrine therapy (80%), although duration is shorter in this presurgical setting  Furtherinvestigations will evaluate length of use, the psychosocial and behavioral factors that influence willingness to takeendocrine therapy, and apply these lessons to management of early-stage hormone-positive breast cancer