Table 1. General Management of Select Early Breast Cancer Scenarios before and during the Covid-19 Pandemic.^*.

Clinical Scenario	Typical Management, before Covid-19 Pandemic	Modified Management, during Covid-19 Pandemic†
Newly diagnosed postmenopausal early HR-positive, HER2-negative breast cancer	Stage I–II: Upfront surgery, followed by adjuvant endocrine therapy (with or without adjuvant chemotherapy, radiation therapy, or both). Stage III: Neoadjuvant therapy, followed by surgery, radiation therapy, and adjuvant therapy.	Stage I–II: Neoadjuvant therapy (endocrine therapy preferred), followed by surgery (with or without adjuvant chemotherapy, radiation therapy, or both). Stage III: Neoadjuvant therapy (endocrine therapy preferred), followed by surgery and radiation therapy (with or without adjuvant chemotherapy).
Newly diagnosed premenopausal early HR-positive, HER2-negative breast cancer	Stage I–II: Upfront surgery, followed by adjuvant endocrine therapy (with or without adjuvant chemotherapy, radiation therapy, or both). Stage III: Neoadjuvant chemotherapy, followed by surgery, radiation therapy, and adjuvant endocrine therapy with ovarian suppression.	Stage I: Neoadjuvant therapy (endocrine therapy preferred), followed by surgery (with or without adjuvant chemotherapy, radiation therapy, or both). Stage II–III: Neoadjuvant therapy (endocrine therapy preferred), followed by surgery, adjuvant chemotherapy, and radiation therapy.
Newly diagnosed localized HER2-amplified breast cancer	Stage I: Upfront surgery, followed by adjuvant HER2-targeted therapy (with or without radiation therapy). Stage II–III: Neoadjuvant HER2-targeted therapy, followed by surgery and adjuvant HER2-targeted therapy (with or without radiation therapy).	Stage I: Modified neoadjuvant HER2-targeted therapy, followed by surgery and adjuvant HER2-targeted therapy (with or without radiation therapy). Stage II–III: Neoadjuvant HER2-targeted therapy, followed by surgery and adjuvant HER2-targeted therapy (with or without radiation therapy).
Newly diagnosed localized triple-negative breast cancer	Stage I: Upfront surgery, followed by adjuvant chemotherapy (with or without radiation therapy). Stage II–III: Neoadjuvant chemotherapy, followed by surgery (with or without radiation therapy).	Stage I: Neoadjuvant chemotherapy, followed by surgery (with or without radiation therapy). Stage II–III: Neoadjuvant chemotherapy, followed by surgery (with or without radiation therapy).

^*Of note, these are broad treatment principles, and there could be exceptions. Ultimately, management of breast cancer needs to be individualized. HER2 denotes human epidermal growth factor receptor 2, and HR hormone receptor.

^†If chemotherapy is deemed absolutely necessary during the Covid-19 pandemic, it is important to consider alterations to chemotherapy regimens, including minimizing glucocorticoid use, to decrease the extent of myelosuppression. Once-weekly paclitaxel could be substituted for paclitaxel given every 2 weeks, with the trade-off of the need for a greater number of visits. Alternatively, docetaxel given every 3 weeks can be used, with growth factor support. For HER2-positive tumors with homogeneous HER2 expression, trastuzumab emtansine (with or without pertuzumab) could be considered instead of chemotherapy, particularly for smaller tumors. For stage I triple-negative breast cancer, docetaxel plus cyclophosphamide may be considered, although for patients for whom chemotherapy is not otherwise recommended, surgery should remain a high priority.