背景:在当前COVID-19大流行时代,癌症患者的管理对医疗保健系统构成了重大挑战。乳腺癌是国际上最常见的癌症。乳腺癌是一种涉及手术的疾病,化疗,激素治疗,靶向治疗,放射治疗,and,最近,免疫疗法在其管理计划中。免疫系统需要几个月才能从这些药物中恢复,这种情况在转移性乳腺癌患者中更严重,他们需要使用这些药物进行治疗。其中一些药物,例如细胞周期蛋白依赖性激酶4和6的抑制剂可引起罕见但危及生命的肺部炎症。患有肺部转移性疾病的乳腺癌患者可能会因为COVID-19感染而出现疾病症状恶化。治疗乳腺癌患者的肿瘤学家在治疗选择方面面临困难。COVID-19对乳腺癌治疗的影响尚不清楚,包括如何在不影响患者和社区安全的情况下提供最佳护理。
目的:本研究的目的是探讨肿瘤学家对COVID-19大流行期间乳腺癌患者管理的看法。
方法:将基于网络的SurveyMonkey问卷提交给沙特阿拉伯参与乳腺癌管理的有执照的肿瘤学家,埃及,和阿拉伯联合酋长国。调查的重点是参与者的特点,癌症患者的感染风险,以及与不同类型乳腺癌相关的可能的治疗修改。
结果:调查由82名参与者完成。对于早期激素受体(HR)阳性,人表皮生长因子受体2(HER2)阴性乳腺癌,82名参与者中有61名(74%)支持在选定的患者中使用新辅助激素治疗,58%(48/82)在有指征时更倾向于给予6个或8个周期的辅助化疗。在所有转移性HR阳性疾病患者中,只有43%(35/82)的人首选激素治疗的细胞周期蛋白依赖性激酶4和6抑制剂作为一线治疗。82名参与者中有55名(67%)支持在选定的HER2阳性乳腺癌患者中使用曲妥珠单抗辅助治疗6个月而不是12个月。对于转移性HER2阳性,HR阳性乳腺癌,80%的参与者(66/82)支持在选定的患者中使用激素治疗和双重抗HER2阻断。在BRCA突变和程序性细胞死亡1配体1(PD-L1)<1%的转移性三阴性患者中,一线治疗的首选是聚(二磷酸腺苷-核糖)聚合酶抑制剂41%(34/82)的参与者,根据71%(58/82)的参与者,对于PD-L1>1%的患者,阿特珠单抗联合nab-紫杉醇是首选方案.
结论:调查参与者支持对乳腺癌管理的一些修改。这些修改需要在当地进行讨论,考虑到当地基础设施和可用资源。
BACKGROUND: Management of patients with cancer in the current era of the COVID-19 pandemic poses a significant challenge to health care systems. Breast cancer is the most common cancer internationally. Breast cancer is a disease that involves surgery, chemotherapy, hormonal therapy, targeted therapy, radiotherapy, and, more recently, immunotherapy in its management plan. The immune system requires months to recover from these medications, and this condition is even worse in patients with metastatic breast cancer who need ongoing treatment with these drugs. Some of these drugs, such as inhibitors of cyclin-dependent kinases 4 and 6, can cause rare but life-threating lung inflammation. Patients with breast cancer who have metastatic disease to the lungs can experience deterioration of disease symptoms with COVID-19 infection. Oncologists treating patients with breast cancer are facing a difficult situation regarding treatment choice. The impact that COVID-19 has had on breast cancer care is unknown, including how to provide the best care possible without compromising patient and community safety.
OBJECTIVE: The aim of this study was to explore the views of oncologists regarding the management of patients with breast cancer during the COVID-19 pandemic.
METHODS: A web-based SurveyMonkey questionnaire was submitted to licensed oncologists involved in breast cancer management in Saudi Arabia, Egypt, and United Arab Emirates. The survey focused on characteristics of the participants, infection risk among patients with cancer, and possible treatment modifications related to different types of breast cancer.
RESULTS: The survey was completed by 82 participants. For early hormone receptor (HR)-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancer, 61 of the 82 participants (74%) supported using neoadjuvant hormonal therapy in selected patients, and 58% (48/82) preferred giving 6 over 8 cycles of adjuvant chemotherapy when indicated. Only 43% (35/82) preferred inhibitors of cyclin-dependent kinases 4 and 6 with hormonal therapy as the first-line treatment in all patients with metastatic HR-positive disease. A total of 55 of the 82 participants (67%) supported using adjuvant trastuzumab for 6 instead of 12 months in selected patients with HER2-positive breast cancer. For metastatic HER2-positive, HR-positive breast cancer, 80% of participants (66/82) supported the use of hormonal therapy with dual anti-HER2 blockade in selected patients. The preferred choice of first-line treatment in metastatic triple negative patients with BRCA mutation and programmed cell death 1 ligand 1 (PD-L1) <1% was poly(adenosine diphosphate-ribose) polymerase inhibitor according to 41% (34/82) of the participants, and atezolizumab with nab-paclitaxel was preferred for PD-L1 >1% according to 71% (58/82) of the participants.
CONCLUSIONS: Several modifications in breast cancer management were supported by the survey participants. These modifications need to be discussed on a local basis, taking into account the local infrastructure and available resources.