Dowsett Mitch, Ellis Matthew J, Dixon J Michael, Gluz Oleg, Robertson John, Kates Ronald, Suman Vera J, Turnbull Arran K, Nitz Ulrike, Christgen Matthias, Kreipe Hans, Kuemmel Sherko, Bliss Judith M, Barry Peter, Johnston Stephen R, Jacobs Samuel A, Ma Cynthia X, Smith Ian E, Harbeck Nadia
Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, London, UK.
Breast Cancer Now Toby Robins Research Centre, Institute of Cancer Research, London, UK.
NPJ Breast Cancer. 2020 Jun 8;6:21. doi: 10.1038/s41523-020-0168-9. eCollection 2020.
Many patients with ER+ HER2- primary breast cancer are being deferred from surgery to neoadjuvant endocrine therapy (NeoET) during the COVID-19 pandemic. We have collated data from multiple international trials of presurgical endocrine therapy in order to provide guidance on the identification of patients who may have insufficiently endocrine-sensitive tumors and should be prioritised for early surgery or neoadjuvant chemotherapy rather than NeoET during or in the aftermath of the COVID-19 pandemic for safety or when surgical activity needs to be prioritized. For postmenopausal patients, our data provide strong support for the use of ER and PgR status at diagnosis for triaging of patients into three groups in which (taking into account clinical factors): (i) NeoET is likely to be inappropriate (Allred ER <6 or ER 6 and PgR <6) (ii) a biopsy for Ki67 analysis (on-treatment Ki67) could be considered after 2-4 weeks of NeoET (a: ER 7 or 8 and PgR <6 or b: ER 6 or 7 and PgR ≥6) or (iii) NeoET is an acceptable course of action (ER 8 and PgR ≥6). Cut-offs for percentage of cells positive are also given. For group (ii), a high early on-treatment level of Ki67 (>10%) indicates a higher priority for early surgery. Too few data were available for premenopausal patients to provide a similar treatment algorithm. These guidelines should be helpful for managing patients with early ER+ HER2- breast cancer during and in the aftermath of the COVID-19 crisis.
在新冠疫情期间，许多雌激素受体阳性（ER+）、人表皮生长因子受体2阴性（HER2-）的原发性乳腺癌患者被推迟手术，转而接受新辅助内分泌治疗（NeoET）。我们整理了多项术前内分泌治疗国际试验的数据，以便为识别那些可能对内分泌不敏感的肿瘤患者提供指导，这些患者应被优先考虑早期手术或新辅助化疗，而非在新冠疫情期间或疫情后出于安全考虑或手术活动需要优先安排时接受NeoET。对于绝经后患者，我们的数据有力支持在诊断时使用雌激素受体（ER）和孕激素受体（PgR）状态将患者分为三组（考虑临床因素）：（i）NeoET可能不合适（Allred ER评分<6或ER为6且PgR<6）；（ii）在NeoET治疗2 - 4周后可考虑进行Ki67分析活检（治疗中Ki67）（a：ER为7或8且PgR<6或b：ER为6或7且PgR≥6）；或（iii）NeoET是可接受的治疗方案（ER为8且PgR≥6）。同时也给出了阳性细胞百分比的临界值。对于第（ii）组，治疗早期Ki67水平高（>10%）表明早期手术的优先级更高。对于绝经前患者，可用数据太少，无法提供类似的治疗算法。这些指南应有助于在新冠疫情期间及疫情后管理早期ER+ HER2-乳腺癌患者。
