De-escalating and escalating treatments for early-stage breast cancer: the St. Gallen International Expert Consensus Conference on the Primary Therapy of Early Breast Cancer 2017

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  • Curigliano, G
  • Burstein, H.J.
    • Other Affiliation: Breast Oncology Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
  • Winer, E.P.
    • Other Affiliation: Breast Oncology Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
  • Gnant, M.
  • Dubsky, P.
    • Other Affiliation: Department of Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
  • Loibl, S.
    • Other Affiliation: German Breast Group, Neu-Isenburg, Germany
  • Colleoni, M.
  • Regan, M.M.
    • Other Affiliation: Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
  • Piccart-Gebhart, M.
    • Other Affiliation: Department of Medical Oncology, Institut Jules Bordet, UniversitÕ Libre de Bruxelles, Brussels, Belgium
  • Senn, H.-J.
    • Other Affiliation: Tumor and Breast Center ZeTuP, St. Gallen
  • Thürlimann, B.
    • Other Affiliation: Breast Center, Kantonsspital St. Gallen, St. Gallen, Switzerland
  • André, F.
  • Baselga, J.
    • Other Affiliation: Memorial Sloan Kettering Cancer Center, New York, USA
  • Bergh, J.
    • Other Affiliation: Karolinska Institute and University Hospital, Stockholm, Sweden
  • Bonnefoi, H.
    • Other Affiliation: University of Bordeaux, Bordeaux, France
  • Brucker, S.Y.
  • Cardoso, F.
  • Carey, L.
  • Ciruelos, E.
  • Cuzick, J.
  • Denkert, C.
  • Di Leo, A.
  • Ejlertsen, B.
    • Other Affiliation: Rigshospitalet, Copenhagen, Denmark
  • Francis, P.
    • Other Affiliation: Peter McCallum Cancer Centre, Melbourne, Australia
  • Galimberti, V.
  • Garber, J.
    • Other Affiliation: Breast Oncology Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
  • Gulluoglu, B.
  • Goodwin, P.
  • Harbeck, N.
  • Hayes, D.F.
    • Other Affiliation: Comprehensive Cancer Center, University of Michigan, Ann-Arbor, USA
  • Huang, C.-S.
  • Huober, J.
    • Other Affiliation: University of Ulm, Ulm, Germany
  • Khaled, H.
    • Other Affiliation: The National Cancer Institute, Cairo University, Cairo, Egypt
  • Jassem, J.
  • Jiang, Z.
    • Other Affiliation: Hospital Affiliated to Military Medical Science, Beijing, China
  • Karlsson, P.
  • Morrow, M.
    • Other Affiliation: Memorial Sloan Kettering Cancer Center, New York, USA
  • Orecchia, R.
    • Other Affiliation: Breast Cancer Program, Istituto Europeo di Oncologia, Milano, Italy
  • Osborne, K.C.
    • Other Affiliation: Baylor College of Medicine, Houston, USA
  • Pagani, O.
    • Other Affiliation: Institute of Oncology Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
  • Partridge, A.H.
    • Other Affiliation: Breast Oncology Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
  • Pritchard, K.
  • Ro, J.
    • Other Affiliation: National Cancer Center, Ilsandong-gu, Goyang-si, Gyeonggi-do, Korea
  • Rutgers, E.J.T.
  • Sedlmayer, F.
  • Semiglazov, V.
  • Shao, Z.
    • Other Affiliation: Fudan University Cancer Hospital, Shanghai, China
  • Smith, I.
    • Other Affiliation: The Royal Marsden, Sutton, Surrey, UK
  • Toi, M.
  • Tutt, A.
  • Viale, G.
    • Other Affiliation: University of Milan, Milan, Italy
  • Watanabe, T.
    • Other Affiliation: Hamamatsu Oncology Center, Hamamatsu, Japan
  • Whelan, T.J.
  • Xu, B.
    • Other Affiliation: National Cancer Center, Chaoyang District, Beijing, China
Abstract

  • The 15th St. Gallen International Breast Cancer Conference 2017 in Vienna, Austria reviewed substantial new evidence on loco-regional and systemic therapies for early breast cancer. Treatments were assessed in light of their intensity, duration and side-effects, seeking where appropriate to escalate or de-escalate therapies based on likely benefits as predicted by tumor stage and tumor biology. The Panel favored several interventions that may reduce surgical morbidity, including acceptance of 2 mm margins for DCIS, the resection of residual cancer (but not baseline extent of cancer) in women undergoing neoadjuvant therapy, acceptance of sentinel node biopsy following neoadjuvant treatment of many patients, and the preference for neoadjuvant therapy in HER2 positive and triple-negative, stage II and III breast cancer. The Panel favored escalating radiation therapy with regional nodal irradiation in high-risk patients, while encouraging omission of boost in low-risk patients. The Panel endorsed gene expression signatures that permit avoidance of chemotherapy in many patients with ER positive breast cancer. For women with higher risk tumors, the Panel escalated recommendations for adjuvant endocrine treatment to include ovarian suppression in premenopausal women, and extended therapy for postmenopausal women. However, low-risk patients can avoid these treatments. Finally, the Panel recommended bisphosphonate use in postmenopausal women to prevent breast cancer recurrence. The Panel recognized that recommendations are not intended for all patients, but rather to address the clinical needs of the majority of common presentations. Individualization of adjuvant therapy means adjusting to the tumor characteristics, patient comorbidities and preferences, and managing constraints of treatment cost and access that may affect care in both the developed and developing world.

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DOI
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Resource type
  • Article
Rights statement
  • In Copyright
Journal title
  • Annals of Oncology
Journal volume
  • 28
Journal issue
  • 8
Page start
  • 1700
Page end
  • 1712
Funder
  • Cancer Research UK
  • National Cancer Institute
ISSN
  • 0923-7534
  • 1569-8041
Publisher
  • Elsevier

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