Prioritising breast treatment

In an international collaboration led by Professor Mitch Dowsett, researchers at The Royal Marsden have developed an innovative approach to selecting breast cancer patients who need urgent treatment.

Using data from multiple international trials, a new algorithm can identify postmenopausal patients with a specific kind of primary breast cancer who should be prioritised for early surgery or neoadjuvant chemotherapy (treatment delivered before surgery).

This algorithm can be used to direct treatment for patients with a type of breast cancer called ER-positive, HER2-negative breast cancer – a type that accounts for 70 per cent of all cases – who have tumours which are less sensitive to oestrogen hormone treatment.

The COVID-19 pandemic led to an international need to triage the most urgent cancer surgery and chemotherapy treatments to protect staff and vulnerable patients. For a large group of breast cancer patients, deferring treatment and prescribing neoadjuvant endocrine (or hormone) therapy (NeoET) to reduce the stimulation of the cancer by oestrogen without the surgical removal of the tumour is the best course of action.

mitch dowsett

However, the work of Professor Dowsett (pictured right) highlighted that while 85 per cent of patients whose surgery is deferred would be safe to remain on NeoET for up to six months, 15 per cent are resistant to this treatment and are at risk of their disease spreading.

Patient Carole Smith, 68, had her operation brought forward after being identified by the new algorithm. She said: “I am so grateful for the researchers making this discovery as [my cancer] could have progressed if left for a few months.”

Professor Dowsett said: "NeoET can block the tumour from growing successfully for many women but for one in six who are resistant there is a risk the tumour will continue to grow and spread elsewhere.

"By accessing unpublished results from clinical trials involving thousands of patients, with colleagues here and abroad we have developed a new way of directing patients' treatment in this global crisis. Using this data, our simple new calculator can be used by fellow clinicians worldwide to immediately identify the best course of treatment for about 80% of their patients. For the other 20%, testing a small biopsy taken shortly after starting treatment can be used to direct their best treatment.

"The speed and openness of this collaboration to help our patients as rapidly as possible has been unparalleled in my 30 years' experience."

Consultant Breast Surgeon at The Royal Marsden, Peter Barry, said: “This innovative algorithm will help clinicians offer the best treatment for their patients during these unprecedented times. I have already identified patients that would have been deferred to receive NeoET, that may well have been at risk of progression within the six months."

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