The implications of coronavirus on the treatment of cancer patients in the UK is still unknown.
As you will be aware, NHS England has issued two sets of guidance notes on this matter (guidance notes available on NHS England website. These documents clearly prioritise surgical, chemotherapy and radiotherapy procedures into different priority bands.
With regard to chemotherapy treatment, there are six priority bands. The top two bands are patients categorised as “high risk” whereby chemotherapy is essential and must proceed without delay. However, if you take breast cancer, for example, the guidance stipulates that patients can be prioritised for chemotherapy treatment by categorising them based on the risk of cancer reoccurring.
In addition, NICE has also issued further useful guidance specifically on to how to select patients for chemo during the coronavirus pandemic and who should not receive it due to immunosuppression, as well as guidance on how to avoid treating COVID-19 positive with COVID-19 negative patients together.
Widening of testing for node-negative and node-positive breast cancer patients due to COVID-19
There has been much discussion within hospitals and trusts around the wider use of Gene Expression Profiling (GEP) testing for both node-negative and node-positive breast cancer patients in order to spare as many patients as possible from receiving chemotherapy whilst at risk of contracting coronavirus.
As a result, and since the heightening of the coronavirus pandemic, Everything Genetic has seen an increase in demand for the Prosigna test for early-stage breast cancer patients.
Prosigna is, as you may be aware, a GEP test recommended by NICE for determining both the risk of reoccurrence in breast cancer patients and to help you and your patient decide if other treatments, particularly chemotherapy, are needed.
Prosigna is indicated for use in postmenopausal women with hormone receptor-positive, node-negative (Stage I or II) or node-positive (Stage II or IIIA) early-stage breast cancer to be treated with adjuvant endocrine therapy. The test uses the PAM50 gene signature to translate tumor biology into your patient’s individualised prognostic score. Advanced technology generates precise, reproducible prognostic information in local qualified laboratories. Prosigna reliably identifies your patient’s 10-year risk of distant recurrence and intrinsic molecular subtype.
Risk of chemotherapy for COVID-19 positive patients still unknown
Immunosuppression is a well-recognised side effect of systemic cancer treatments be they chemotherapeutic or immunotherapeutic, and the data does not yet exist to show whether outcomes or disease response can be adversely affected by COVID-19. It is believed that in light of the COVID-19 pandemic, the risk to patient outweighs the benefit of chemotherapy in certain populations and GEP testing using the Prosigna service will help to clarify this for both clinicians and patients alike. This will also help you to better explain any decision to delay or cancel chemotherapy, or your recommendation to consider other forms of treatment at this time. (See paper entitled ‘Immunological Effects of Conventional Chemotherapy and Targeted Anticancer Agents’)
By expanding the use of the Prosigna test to include node-positive patients, and following the guidance issued by NHS England and NICE, clinicians will be able to make informed treatment decisions and personalised care plans which will help to reduce the number of patients receiving chemo treatment, perhaps unnecessarily, whilst at risk from contracting coronavirus.
Everything Genetic is reducing the price of the Prosigna node-positive service
In support of this, Everything Genetic has reduced the cost of the Prosigna node-positive testing service to match the price of the NHS England node-negative test.
In order to access this service, your NHS Trust would need to agree to fund and sign an agreement with Everything Genetic Ltd. What’s more, the Prosigna testing service is UK-based with minimal logistics required and supported by an expediated turnaround time (6 days turnaround time from sample received to results published).
If you would like more information about our Prosigna testing service, please contact Simon Davis, Commercial Director:
Tel: +44 (0) 7840 050413