Personalizing the treatment of women with early breast cancer

Highlights of the st gallen international expert consensus on the primary therapy of early breast Cancer 2013

A. Goldhirsch, E. P. Winer, A. S. Coates, R. D. Gelber, M. Piccart-Gebhart, B. Thürlimann, H. J. Senn, Kathy S. Albain, Fabrice André, Jonas Bergh, Hervé Bonnefoi, Denisse Bretel-Morales, Harold Burstein, Fatima Cardoso, Monica Castiglione-Gertsch, Alan S. Coates, Marco Colleoni, Alberto Costa, Giuseppe Curigliano, Nancy E. Davidson & 38 others Angelo Di Leo, Bent Ejlertsen, John F. Forbes, Richard D. Gelber, Michael Gnant, Aron Goldhirsch, Pamela Goodwin, Paul E. Goss, Jay R. Harris, Daniel F. Hayes, Clifford A. Hudis, James N. Ingle, Jacek Jassem, Zefei Jiang, Per Karlsson, Sibylle Loibl, Monica Morrow, Moise Namer, C. Kent Osborne, Ann H. Partridge, Frédérique Penault-Llorca, Charles M. Perou, Martine J. Piccart-Gebhart, Kathleen I. Pritchard, Emiel J T Rutgers, Felix Sedlmayer, Vladimir Semiglazov, Zhi Ming Shao, Ian Smith, Beat Thürlimann, Masakazu Toi, Andrew Tutt, Michael Untch, Giuseppe Viale, Toru Watanabe, Nicholas Wilcken, Eric P. Winer, William C. Wood

Research output: Contribution to journalArticle

Abstract

The 13th St Gallen International Breast Cancer Conference (2013) Expert Panel reviewed and endorsed substantial new evidence on aspects of the local and regional therapies for early breast cancer, supporting less extensive surgery to the axilla and shorter durations of radiation therapy. It refined its earlier approach to the classification and management of luminal disease in the absence of amplification or overexpression of the Human Epidermal growth factor Receptor 2 (HER2) oncogene, while retaining essentially unchanged recommendations for the systemic adjuvant therapy of HER2-positive and 'triple-negative' disease. The Panel again accepted that conventional clinico-pathological factors provided a surrogate subtype classification, while noting that in those areas of the world where multi-gene molecular assays are readily available many clinicians prefer to base chemotherapy decisions for patients with luminal disease on these genomic results rather than the surrogate subtype definitions. Several multi-gene molecular assays were recognized as providing accurate and reproducible prognostic information, and in some cases prediction of response to chemotherapy. Cost and availability preclude their application in many environments at the present time. Broad treatment recommendations are presented. Such recommendations do not imply that each Panel member agrees: indeed, among more than 100 questions, only one (trastuzumab duration) commanded 100% agreement. The various recommendations in fact carried differing degrees of support, as reflected in the nuanced wording of the text below and in the votes recorded in supplementary Appendix S1, available at Annals of Oncology online. Detailed decisions on treatment will as always involve clinical consideration of disease extent, host factors, patient preferences and social and economic constraints.

Original languageEnglish (US)
Article numbermdt303
Pages (from-to)2206-2223
Number of pages18
JournalAnnals of Oncology
Volume24
Issue number9
DOIs
StatePublished - Sep 2013
Externally publishedYes

Fingerprint

Breast Neoplasms
Drug Therapy
Axilla
Patient Preference
Therapeutics
Disease Management
Oncogenes
Genes
Radiotherapy
Economics
Costs and Cost Analysis
human ERBB2 protein
Trastuzumab

Keywords

  • Early breast cancer
  • Radiation therapy
  • St Gallen consensus
  • Subtypes
  • Surgery
  • Systemic adjuvant therapies

ASJC Scopus subject areas

  • Oncology
  • Hematology

Cite this

Goldhirsch, A., Winer, E. P., Coates, A. S., Gelber, R. D., Piccart-Gebhart, M., Thürlimann, B., ... Wood, W. C. (2013). Personalizing the treatment of women with early breast cancer: Highlights of the st gallen international expert consensus on the primary therapy of early breast Cancer 2013. Annals of Oncology, 24(9), 2206-2223. [mdt303]. https://doi.org/10.1093/annonc/mdt303

Personalizing the treatment of women with early breast cancer : Highlights of the st gallen international expert consensus on the primary therapy of early breast Cancer 2013. / Goldhirsch, A.; Winer, E. P.; Coates, A. S.; Gelber, R. D.; Piccart-Gebhart, M.; Thürlimann, B.; Senn, H. J.; Albain, Kathy S.; André, Fabrice; Bergh, Jonas; Bonnefoi, Hervé; Bretel-Morales, Denisse; Burstein, Harold; Cardoso, Fatima; Castiglione-Gertsch, Monica; Coates, Alan S.; Colleoni, Marco; Costa, Alberto; Curigliano, Giuseppe; Davidson, Nancy E.; Leo, Angelo Di; Ejlertsen, Bent; Forbes, John F.; Gelber, Richard D.; Gnant, Michael; Goldhirsch, Aron; Goodwin, Pamela; Goss, Paul E.; Harris, Jay R.; Hayes, Daniel F.; Hudis, Clifford A.; Ingle, James N.; Jassem, Jacek; Jiang, Zefei; Karlsson, Per; Loibl, Sibylle; Morrow, Monica; Namer, Moise; Osborne, C. Kent; Partridge, Ann H.; Penault-Llorca, Frédérique; Perou, Charles M.; Piccart-Gebhart, Martine J.; Pritchard, Kathleen I.; Rutgers, Emiel J T; Sedlmayer, Felix; Semiglazov, Vladimir; Shao, Zhi Ming; Smith, Ian; Thürlimann, Beat; Toi, Masakazu; Tutt, Andrew; Untch, Michael; Viale, Giuseppe; Watanabe, Toru; Wilcken, Nicholas; Winer, Eric P.; Wood, William C.

In: Annals of Oncology, Vol. 24, No. 9, mdt303, 09.2013, p. 2206-2223.

Research output: Contribution to journalArticle

Goldhirsch, A, Winer, EP, Coates, AS, Gelber, RD, Piccart-Gebhart, M, Thürlimann, B, Senn, HJ, Albain, KS, André, F, Bergh, J, Bonnefoi, H, Bretel-Morales, D, Burstein, H, Cardoso, F, Castiglione-Gertsch, M, Coates, AS, Colleoni, M, Costa, A, Curigliano, G, Davidson, NE, Leo, AD, Ejlertsen, B, Forbes, JF, Gelber, RD, Gnant, M, Goldhirsch, A, Goodwin, P, Goss, PE, Harris, JR, Hayes, DF, Hudis, CA, Ingle, JN, Jassem, J, Jiang, Z, Karlsson, P, Loibl, S, Morrow, M, Namer, M, Osborne, CK, Partridge, AH, Penault-Llorca, F, Perou, CM, Piccart-Gebhart, MJ, Pritchard, KI, Rutgers, EJT, Sedlmayer, F, Semiglazov, V, Shao, ZM, Smith, I, Thürlimann, B, Toi, M, Tutt, A, Untch, M, Viale, G, Watanabe, T, Wilcken, N, Winer, EP & Wood, WC 2013, 'Personalizing the treatment of women with early breast cancer: Highlights of the st gallen international expert consensus on the primary therapy of early breast Cancer 2013', Annals of Oncology, vol. 24, no. 9, mdt303, pp. 2206-2223. https://doi.org/10.1093/annonc/mdt303
Goldhirsch, A. ; Winer, E. P. ; Coates, A. S. ; Gelber, R. D. ; Piccart-Gebhart, M. ; Thürlimann, B. ; Senn, H. J. ; Albain, Kathy S. ; André, Fabrice ; Bergh, Jonas ; Bonnefoi, Hervé ; Bretel-Morales, Denisse ; Burstein, Harold ; Cardoso, Fatima ; Castiglione-Gertsch, Monica ; Coates, Alan S. ; Colleoni, Marco ; Costa, Alberto ; Curigliano, Giuseppe ; Davidson, Nancy E. ; Leo, Angelo Di ; Ejlertsen, Bent ; Forbes, John F. ; Gelber, Richard D. ; Gnant, Michael ; Goldhirsch, Aron ; Goodwin, Pamela ; Goss, Paul E. ; Harris, Jay R. ; Hayes, Daniel F. ; Hudis, Clifford A. ; Ingle, James N. ; Jassem, Jacek ; Jiang, Zefei ; Karlsson, Per ; Loibl, Sibylle ; Morrow, Monica ; Namer, Moise ; Osborne, C. Kent ; Partridge, Ann H. ; Penault-Llorca, Frédérique ; Perou, Charles M. ; Piccart-Gebhart, Martine J. ; Pritchard, Kathleen I. ; Rutgers, Emiel J T ; Sedlmayer, Felix ; Semiglazov, Vladimir ; Shao, Zhi Ming ; Smith, Ian ; Thürlimann, Beat ; Toi, Masakazu ; Tutt, Andrew ; Untch, Michael ; Viale, Giuseppe ; Watanabe, Toru ; Wilcken, Nicholas ; Winer, Eric P. ; Wood, William C. / Personalizing the treatment of women with early breast cancer : Highlights of the st gallen international expert consensus on the primary therapy of early breast Cancer 2013. In: Annals of Oncology. 2013 ; Vol. 24, No. 9. pp. 2206-2223.
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abstract = "The 13th St Gallen International Breast Cancer Conference (2013) Expert Panel reviewed and endorsed substantial new evidence on aspects of the local and regional therapies for early breast cancer, supporting less extensive surgery to the axilla and shorter durations of radiation therapy. It refined its earlier approach to the classification and management of luminal disease in the absence of amplification or overexpression of the Human Epidermal growth factor Receptor 2 (HER2) oncogene, while retaining essentially unchanged recommendations for the systemic adjuvant therapy of HER2-positive and 'triple-negative' disease. The Panel again accepted that conventional clinico-pathological factors provided a surrogate subtype classification, while noting that in those areas of the world where multi-gene molecular assays are readily available many clinicians prefer to base chemotherapy decisions for patients with luminal disease on these genomic results rather than the surrogate subtype definitions. Several multi-gene molecular assays were recognized as providing accurate and reproducible prognostic information, and in some cases prediction of response to chemotherapy. Cost and availability preclude their application in many environments at the present time. Broad treatment recommendations are presented. Such recommendations do not imply that each Panel member agrees: indeed, among more than 100 questions, only one (trastuzumab duration) commanded 100{\%} agreement. The various recommendations in fact carried differing degrees of support, as reflected in the nuanced wording of the text below and in the votes recorded in supplementary Appendix S1, available at Annals of Oncology online. Detailed decisions on treatment will as always involve clinical consideration of disease extent, host factors, patient preferences and social and economic constraints.",
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AU - Winer, E. P.

AU - Coates, A. S.

AU - Gelber, R. D.

AU - Piccart-Gebhart, M.

AU - Thürlimann, B.

AU - Senn, H. J.

AU - Albain, Kathy S.

AU - André, Fabrice

AU - Bergh, Jonas

AU - Bonnefoi, Hervé

AU - Bretel-Morales, Denisse

AU - Burstein, Harold

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AU - Coates, Alan S.

AU - Colleoni, Marco

AU - Costa, Alberto

AU - Curigliano, Giuseppe

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AU - Leo, Angelo Di

AU - Ejlertsen, Bent

AU - Forbes, John F.

AU - Gelber, Richard D.

AU - Gnant, Michael

AU - Goldhirsch, Aron

AU - Goodwin, Pamela

AU - Goss, Paul E.

AU - Harris, Jay R.

AU - Hayes, Daniel F.

AU - Hudis, Clifford A.

AU - Ingle, James N.

AU - Jassem, Jacek

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AU - Karlsson, Per

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AU - Semiglazov, Vladimir

AU - Shao, Zhi Ming

AU - Smith, Ian

AU - Thürlimann, Beat

AU - Toi, Masakazu

AU - Tutt, Andrew

AU - Untch, Michael

AU - Viale, Giuseppe

AU - Watanabe, Toru

AU - Wilcken, Nicholas

AU - Winer, Eric P.

AU - Wood, William C.

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