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Multicenter Study
. 2023 Jun;199(2):265-279.
doi: 10.1007/s10549-023-06893-4. Epub 2023 Apr 3.

Bridging pre-surgical endocrine therapy for breast cancer during the COVID-19 pandemic: outcomes from the B-MaP-C study

Rajiv V Dave  1   2 , Beatrix Elsberger  3 , Vicky P Taxiarchi  4 , Ashu Gandhi  5   6 , Cliona C Kirwan  5   6 , Baek Kim  7 , Elizabeth M Camacho  4 , Charlotte E Coles  8 , Ellen Copson  9 , Alona Courtney  10 , Kieran Horgan  7 , Patricia Fairbrother  11 , Chris Holcombe  12 , Jamie J Kirkham  4 , Daniel R Leff  10 , Stuart A McIntosh  13 , Rachel O'Connell  14 , Ricardo Pardo  15 , Shelley Potter  16   17 , Tim Rattay  18 , Nisha Sharma  19 , Raghavan Vidya  20 , Ramsey I Cutress  9 ; B-MaP-C study collaborative
Collaborators, Affiliations
Multicenter Study

Bridging pre-surgical endocrine therapy for breast cancer during the COVID-19 pandemic: outcomes from the B-MaP-C study

Rajiv V Dave et al. Breast Cancer Res Treat. 2023 Jun.

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.

Keywords: Breast cancer; Bridging endocrine therapy; COVID-19; Neoadjuvant endocrine therapy.

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Conflict of interest statement

Baek Kim, Alona Courtney, Rachel O’Connell, Vicky P Taxiarchi, Raghavan Vidya, Jamie J Kirkham, Patricia Fairbrother, Nisha Sharma, Christopher W.J. Cartlidge, Kieran Horgan, Shelley Potter, Ashu Gandhi, Stuart A McIntosh, Elizabeth Camacho, Daniel R Leff and Chris Holcombe have nothing to declare. Rajiv V Dave (RVD) has received honoraria from Roche and support from Endomag. Dr Tim Rattay (TR) is currently an NIHR Clinical Lecturer. Charlotte E Coles (CEC) is supported by the National Institute Health Research Cambridge Biomedical Research Centre. Ramsey I Cutress (RIC) has equipment provided by Seca to analyse body composition to University Hospital Southampton as part of a NIHR model industry collaborative agreement (MiCA). This equipment is used in an Academic Investigator led charity funded study of which Ramsey Cutress is CI. Ellen Copson (EC) declares honoraria from: Roche, Pfizer, Astra-Zeneca, Lilly, Nanostring and expert panel work for World Cancer Research Fund. Cliona C Kirwan (CCK) is Royal College of Surgeons/University of Manchester Professor of Surgical trials funded by a Royal College of Surgeons of England / Masonic Charitable Foundation professorship.

Figures

Fig. 1
Fig. 1
Consort diagram summarising the inclusion of patients in this study
Fig. 2
Fig. 2
Use of BrET over time, compared to COVID-19 diagnosis, March–July 2022. Figure shows the changing trend in use of BrET over time (date of breast cancer diagnosis) showing UK data only. Data on COVID-19 diagnoses over period 16th March to 31st July 2022 from: https://coronavirus.data.gov.uk/details/cases
Fig. 3
Fig. 3
Length of time on BrET. Figure shows the length of time on BrET, determined as the time between prescription of BrET and date of surgery, in days
Fig. 4
Fig. 4
Absolute change in Ki67 against time on BrET. Figure shows the absolute change in KI67 between the diagnostic core biopsy and the excision/pre-operative repeat core biopsy
See this image and copyright information in PMC

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