Tailoring therapies - Improving the management of early breast cancer: St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2015 Journal Article
| Authors: | Coates, A. S.; Winer, E. P.; Goldhirsch, A.; Gelber, R. D.; Gnant, M.; Piccart-Gebhart, M.; Thürlimann, B.; Senn, H. J.; & Panel Members |
| Contributors: | Baselga, J.; Hudis, C. A.; Morrow, M. |
| Article Title: | Tailoring therapies - Improving the management of early breast cancer: St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2015 |
| Abstract: | The 14th St Gallen International Breast Cancer Conference (2015) reviewed substantial new evidence on locoregional and systemic therapies for early breast cancer. Further experience has supported the adequacy of tumor margins defined as 'no ink on invasive tumor or DCIS' and the safety of omitting axillary dissection in specific cohorts. Radiotherapy trials support irradiation of regional nodes in node-positive disease. Considering subdivisions within luminal disease, the Panel was more concerned with indications for the use of specific therapies, rather than surrogate identification of intrinsic subtypes as measured by multiparameter molecular tests. For the treatment of HER2-positive disease in patients with node-negative cancers up to 1 cm, the Panel endorsed a simplified regimen comprising paclitaxel and trastuzumab without anthracycline as adjuvant therapy. For premenopausal patients with endocrine responsive disease, the Panel endorsed the role of ovarian function suppression with either tamoxifen or exemestane for patients at higher risk. The Panel noted the value of an LHRH agonist given during chemotherapy for premenopausal women with ER-negative disease in protecting against premature ovarian failure and preserving fertility. The Panel noted increasing evidence for the prognostic value of commonly used multiparameter molecular markers, some of which also carried prognostic information for late relapse. The Panel noted that the results of such tests, where available, were frequently used to assist decisions about the inclusion of cytotoxic chemotherapy in the treatment of patients with luminal disease, but noted that threshold values had not been established for this purpose for any of these tests. Multiparameter molecular assays are expensive and therefore unavailable in much of the world. The majority of new breast cancer cases and breast cancer deaths now occur in less developed regions of the world. In these areas, less expensive pathology tests may provide valuable information. The Panel recommendations on treatment are not intended to apply to all patients, but rather to establish norms appropriate for the majority. Again, economic considerations may require that less expensive and only marginally less effective therapies may be necessary in less resourced areas. Panel recommendations do not imply unanimous agreement among Panel members. Indeed, very few of the 200 questions received 100% agreement from the Panel. In the text below, wording is intended to convey the strength of Panel support for each recommendation, while details of Panel voting on each question are available in supplementary Appendix S2, available at Annals of Oncology online. © The Author 2015. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. |
| Keywords: | gene mutation; overall survival; cancer combination chemotherapy; drug efficacy; drug safety; monotherapy; paclitaxel; cancer adjuvant therapy; cancer radiotherapy; disease free survival; postoperative care; chemotherapy, adjuvant; radiotherapy, adjuvant; cancer staging; recurrence risk; lymph node metastasis; antineoplastic agent; lymph node dissection; neoplasm staging; lymph node excision; tumor associated leukocyte; metabolism; breast cancer; mastectomy; antineoplastic combined chemotherapy protocols; epidermal growth factor receptor 2; bisphosphonic acid derivative; practice guideline; pathology; breast neoplasms; brca1 protein; brca2 protein; cancer therapy; high risk patient; age; cancer hormone therapy; tumor suppressor gene; early cancer; adjuvant chemotherapy; partial mastectomy; gefitinib; practice guidelines as topic; tamoxifen; vitamin supplementation; surgery; cancer registry; consensus development; radiation therapy; receptor, erbb-2; receptors, estrogen; receptors, progesterone; platinum derivative; taxoids; vitamin d deficiency; letrozole; gonadorelin derivative; antineoplastic agents, hormonal; platinum complex; taxane derivative; platinum compounds; cancer control; axilla; anthracycline derivative; estrogen receptor; progesterone receptor; lifestyle modification; trastuzumab; anthracycline; risk reduction; anthracyclines; drug contraindication; adjuvant radiotherapy; lapatinib; antineoplastic hormone agonists and antagonists; carcinoma, intraductal, noninfiltrating; mastectomy, segmental; taxoid; pertuzumab; international cooperation; carcinoma, ductal, breast; carcinoma, lobular; ovarian preservation; clinical trial (topic); erbb2 protein, human; triple negative breast cancer; procedures; early breast cancer; premature ovarian failure; st gallen consensus; systemic adjuvant therapies; humans; human; female; priority journal; article; palbociclib |
| Journal Title: | Annals of Oncology |
| Volume: | 26 |
| Issue: | 8 |
| ISSN: | 0923-7534 |
| Publisher: | Oxford University Press |
| Date Published: | 2015-08-01 |
| Start Page: | 1533 |
| End Page: | 1546 |
| Language: | English |
| DOI: | 10.1093/annonc/mdv221 |
| PUBMED: | 25939896 |
| PROVIDER: | scopus |
| PMCID: | PMC4511219 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 5 June 2017 -- Source: Scopus |
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