Choppa Adrian, Bhimani Fardeen, Foley Angela, Oh Sun Young, Makower Della, Feldman Sheldon, Johnson Kelly, Bteich Fernand, Ramesh K H, McEvoy Maureen P
Breast Surgery Division, Department of Surgery, Montefiore Medical Center, Montefiore Einstein Center for Cancer Care, Bronx, NY, USA.
Albert Einstein College of Medicine, Bronx, NY, USA.
Gland Surg. 2024 Jun 30;13(6):1045-1053. doi: 10.21037/gs-23-447. Epub 2024 Jun 21.
Coronavirus disease 19 (COVID-19) has played a pivotal role in changing medical care around the world. During the pandemic, the operating rooms (ORs) were closed to elective surgery. Since breast cancer surgery is not regarded as an emergent procedure, there was an adoption of treatment regimen modification due to delays in treatment. Therefore, a decision was made to bridge early-stage HER2-positive breast cancer patients with neoadjuvant treatment to postpone surgery. Consequently, to reduce the frequency of dosing and the number of visits, as well as avoid steroid premedication, these patients were treated with ado-trastuzumab emtansine (T-DM1) every three weeks as opposed to weekly taxol and herceptin (TH).
Five patients with early-stage HER2-positive cancer were treated with neoadjuvant T-DM1 3.6 mg/kg IV every three weeks. Three of the five patients developed cancer progression identified by their physical exam and/or imaging. T-DM1 was discontinued, and all three patients underwent immediate surgery. The remaining two patients, 4 and 5, had a complete and partial pathological response, respectively. All five patients received adjuvant therapy after surgery, and currently, none of these patients show evidence of disease on follow-up.
Our findings underscore the obstacles and treatment challenges encountered during the COVID-19 pandemic while preventing the spread of the virus and cancer progression. Furthermore, the use of T-DM1 for neoadjuvant treatment remains controversial, particularly when T-DM1 is used as a bridge to surgery during critical times. Perhaps better patient selection or a different drug regimen could have resulted in a better outcome in our study.
新型冠状病毒肺炎（COVID-19）在改变全球医疗护理方面发挥了关键作用。在疫情期间，手术室停止了择期手术。由于乳腺癌手术不被视为急诊手术，因此因治疗延迟而采用了治疗方案调整。因此，决定对早期人表皮生长因子受体2（HER2）阳性乳腺癌患者采用新辅助治疗来推迟手术。因此，为了减少给药频率和就诊次数，并避免使用类固醇进行预处理，这些患者每三周接受一次ado曲妥珠单抗（ado-trastuzumab emtansine，T-DM1）治疗，而不是每周使用紫杉醇和赫赛汀（TH）。
5例早期HER2阳性癌症患者每三周静脉注射3.6 mg/kg新辅助T-DM1。5例患者中有3例经体格检查和/或影像学检查确定发生癌症进展。停用T-DM1，所有3例患者均立即接受手术。其余2例患者，即患者4和患者5，分别有完全和部分病理缓解。所有5例患者术后均接受辅助治疗，目前，这些患者在随访中均未显示疾病迹象。
我们的研究结果强调了在COVID-19大流行期间在防止病毒传播和癌症进展时遇到的障碍和治疗挑战。此外，T-DM1用于新辅助治疗仍存在争议，特别是在关键时期将T-DM1用作手术过渡治疗时。也许更好的患者选择或不同的药物方案可能会在我们的研究中产生更好的结果。
