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Table of Contents
Year : 2020  |  Volume : 3  |  Issue : 2  |  Page : 332-333

Coronavirus disease-2019 and systemic therapy for breast cancer

1 Department of Medical Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
2 Department of Oncology, BKL Walawalkar Rural Medical College and Hospital, Ratnagiri, Maharashtra, India

Date of Submission06-May-2020
Date of Decision09-May-2020
Date of Acceptance11-May-2020
Date of Web Publication19-Jun-2020

Correspondence Address:
Hollis DSouza
Department of Medical Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/CRST.CRST_173_20

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How to cite this article:
DSouza H, Kulkarni AM. Coronavirus disease-2019 and systemic therapy for breast cancer. Cancer Res Stat Treat 2020;3:332-3

How to cite this URL:
DSouza H, Kulkarni AM. Coronavirus disease-2019 and systemic therapy for breast cancer. Cancer Res Stat Treat [serial online] 2020 [cited 2020 Sep 18];3:332-3. Available from: http://www.crstonline.com/text.asp?2020/3/2/332/287221

India reported its first case of coronavirus disease-2019 (COVID-19) on January 30, 2020, and as of today, there are more than 56,000 cases with 1800 deaths.[1] Oncologists are facing an unprecedented challenge during the COVID-19 pandemic.[2],[3] Breast cancer is the most common malignancy in India.[4] The systemic treatment of breast cancer poses a unique challenge in this pandemic, as it has substantial clinical benefits and deferral of treatment can lead to poor oncologic outcomes.[5] This highlights the need for a framework of guidelines. In normal times, these recommendations would be evidence-based; however, currently, the lack of robust clinical data has prompted the American Society of Breast Surgeons,[6] the National Comprehensive Cancer Network,[7] and the European Society of Medical Oncology [8] to provide consensus and expert-based recommendations. Chellapuram et al.,[9] in the previous issue of the Journal, have put forth their recommendations and institutional practice guidelines for systemic therapy in breast cancer. They can be briefly summarized as below.

  1. Proper personal and patient protection practices [10]
  2. Limiting physical interaction between the healthcare workers and patients by telemedicine, virtual tumor boards, and patient triage in screening areas
  3. Completion of neoadjuvant, adjuvant, and early-line palliative therapies, especially in triple-negative breast cancer (TNBC) and HER2-positive breast cancer
  4. Modification of regimens: to convert weekly regimens into 3-weekly ones, use of prophylactic growth factor support, less myelosuppressive regimens, curtailing the duration of maintenance therapies, avoiding corticosteroids, and the use of oral chemotherapy regimens
  5. Stratifying patients into age groups of ≤50 years, ≤50 years with comorbidity or >50 years without comorbidity, and >50 years with comorbidities and tailoring treatment according to the group
  6. The specific therapy-related guidelines include avoidance of CDK4/6 inhibitors; use of lapatinib/capecitabine in later lines for metastatic HER2-positive tumors; neoadjuvant hormonal therapy, especially in the luminal A subset; and initiating neoadjuvant therapy in early operable TNBC and HER2-positive breast cancers, if elective surgeries are delayed

These recommendations are a reckoner during this pandemic in the Indian setting and can guide us in the optimal systemic treatment of breast cancers. Specific therapy-based recommendations that need to be considered are the use of four cycles of docetaxel plus cyclophosphamide, rather than eight cycles of anthracycline plus taxane, in low-risk patients such as those with node-negative and hormone receptor-positive breast cancers or those with TNBCs smaller than 10 mm in size with negative nodes;[11] the use of pertuzumab plus trastuzumab in a neoadjuvant, adjuvant, or metastatic setting in HER2-positive cancers; and replacing injectable bisphosphonates with oral alternatives. An important recommendation that needs to be highlighted is the feasibility of home-based infusion chemotherapy regimens. This can only be done with the collaborative efforts of the Indian oncology societies and updated government guidelines.

The authors recommend withholding immune checkpoint inhibitors to mitigate the risk of pneumonitis, but the National Health Service, in its interim guidance, recommends atezolizumab for patients with metastatic TNBC to reduce the risk of neutropenia.[12] Although there are no specific recommendations to interrupt the use of immune checkpoint inhibitors during the pandemic,[13],[14] our knowledge of COVID-19 and its impact on cancer care is evolving, and in time, we will be better equipped with more robust data.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Available from: https://www.covid19india.org/. [Last accessed on 2020 May 08].  Back to cited text no. 1
Lewis MA. Between Scylla and Charybdis-oncologic decision making in the time of COVID-19. NEJM. 2020;7. https://doi.org/10.1056/NEJMp2006588.  Back to cited text no. 2
Noronha V, Behel V. Catch-22: COVID versus cancer. Cancer Res Stat Treat 2020;3 Suppl S1:1-2.  Back to cited text no. 3
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68:394-424.  Back to cited text no. 4
Hanna TP, Evans GA, Booth CM. Cancer, COVID-19 and the precautionary principle: Prioritizing treatment during a global pandemic. Nat Rev Clin Oncol 2020;17:268-70.  Back to cited text no. 5
The American Society of Breast Surgeons. ASBrS. Available from: https://www.breastsurgeons.org/. [Last accessed on 2020 May 08].  Back to cited text no. 6
Recommendations for Prioritization, Treatment and Triage of Breast Cancer Patients during the COVID-19 Pandemic. Available from: https://www.nccn.org/covid-19/. [Last accessed on 2020 May 08].  Back to cited text no. 7
ESMO Management and Treatment Adapted Recommendations in the COVID-19 Era: Breast Cancer. Available from: https://www.esmo.org/guidelines. [Last accessed on 2020 May 06].  Back to cited text no. 8
Chellapuram SK, Gogia A. Systemic therapy for breast cancer during SARS- CoV-2 pandemic. Cancer Res Stat Treat 2020;3 Suppl S1:35-9.  Back to cited text no. 9
Srivastava P, Tilak TV, Patel A, Das CK, Biswas B, Mahindru S, et al. Advisory for cancer patients during the COVID pandemic. Cancer Res Stat Treat 2020;3 Suppl S1:145-8.  Back to cited text no. 10
Shahi F, Mirzania M, Aghili M, Dabiri M, Seifi S, Bary A, et al. Modifications in Breast Cancer Guidelines in COVID-19 Pandemic; An Iranian Consensus. Arch Breast Cancer 2020;22;14-1.  Back to cited text no. 11
Thomas VM, Mathew A. Immunotherapy during the COVID-19 pandemic. Cancer Res Stat Treat 2020;3 Suppl S1:149.  Back to cited text no. 14

This article has been cited by
1 Authorsę reply to DęSouza et al.
SantoshKumar Chellapuram,Ajay Gogia
Cancer Research, Statistics, and Treatment. 2020; 3(2): 334
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