Tailoring therapies-improving the management of early breast cancer: St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2015

Alan S. Coates, Eric P. Winer, Aron Goldhirsch, Richard D. Gelber, Michael Gnant, Martine J. Piccart-Gebhart, Beat Thürlimann, H. J. Senn, Fabrice André, José Baselga, Jonas Bergh, Hervé Bonnefoi, Harold Burstein, Fatima Cardoso, Monica Castiglione-Gertsch, Marco Colleoni, Giuseppe Curigliano, Nancy E. Davidson, Angelo Di Leo, Bent EjlertsenJohn F. Forbes, Viviana Galimberti, Pamela Goodwin, Nadia Harbeck, Daniel F. Hayes, Jens Huober, Clifford A. Hudis, James N. Ingle, Jacek Jassem, Zefei Jiang, Per Karlsson, Monica Morrow, Roberto Orecchia, C. Kent Osborne, Ann H. Partridge, Lorena de la Peña, Kathleen I. Pritchard, Emiel J T Rutgers, Felix Sedlmayer, Vladimir Semiglazov, Zhi Ming Shao, Ian Smith, Masakazu Toi, Andrew Tutt, Giuseppe Viale, Gunter von Minckwitz, Toru Watanabe, Timothy Whelan, Binghe Xu

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)1533-1546
Number of pages14
JournalAnnals of Oncology
Volume26
Issue number8
DOIs
StatePublished - 2015
Externally publishedYes

Fingerprint

Breast Neoplasms
exemestane
Therapeutics
Primary Ovarian Insufficiency
Endocrine System Diseases
Drug Therapy
Neoplasms
Ink
Carcinoma, Intraductal, Noninfiltrating
Anthracyclines
Tamoxifen
Politics
Paclitaxel
Gonadotropin-Releasing Hormone
Fertility
Dissection
Radiotherapy
Economics
Pathology
Safety

Keywords

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

ASJC Scopus subject areas

  • Oncology
  • Hematology

Cite this

Tailoring therapies-improving the management of early breast cancer : St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2015. / Coates, Alan S.; Winer, Eric P.; Goldhirsch, Aron; Gelber, Richard D.; Gnant, Michael; Piccart-Gebhart, Martine J.; Thürlimann, Beat; Senn, H. J.; André, Fabrice; Baselga, José; Bergh, Jonas; Bonnefoi, Hervé; Burstein, Harold; Cardoso, Fatima; Castiglione-Gertsch, Monica; Colleoni, Marco; Curigliano, Giuseppe; Davidson, Nancy E.; Leo, Angelo Di; Ejlertsen, Bent; Forbes, John F.; Galimberti, Viviana; Goodwin, Pamela; Harbeck, Nadia; Hayes, Daniel F.; Huober, Jens; Hudis, Clifford A.; Ingle, James N.; Jassem, Jacek; Jiang, Zefei; Karlsson, Per; Morrow, Monica; Orecchia, Roberto; Kent Osborne, C.; Partridge, Ann H.; de la Peña, Lorena; Pritchard, Kathleen I.; Rutgers, Emiel J T; Sedlmayer, Felix; Semiglazov, Vladimir; Shao, Zhi Ming; Smith, Ian; Toi, Masakazu; Tutt, Andrew; Viale, Giuseppe; von Minckwitz, Gunter; Watanabe, Toru; Whelan, Timothy; Xu, Binghe.

In: Annals of Oncology, Vol. 26, No. 8, 2015, p. 1533-1546.

Research output: Contribution to journalArticle

Coates, AS, Winer, EP, Goldhirsch, A, Gelber, RD, Gnant, M, Piccart-Gebhart, MJ, Thürlimann, B, Senn, HJ, André, F, Baselga, J, Bergh, J, Bonnefoi, H, Burstein, H, Cardoso, F, Castiglione-Gertsch, M, Colleoni, M, Curigliano, G, Davidson, NE, Leo, AD, Ejlertsen, B, Forbes, JF, Galimberti, V, Goodwin, P, Harbeck, N, Hayes, DF, Huober, J, Hudis, CA, Ingle, JN, Jassem, J, Jiang, Z, Karlsson, P, Morrow, M, Orecchia, R, Kent Osborne, C, Partridge, AH, de la Peña, L, Pritchard, KI, Rutgers, EJT, Sedlmayer, F, Semiglazov, V, Shao, ZM, Smith, I, Toi, M, Tutt, A, Viale, G, von Minckwitz, G, Watanabe, T, Whelan, T & Xu, B 2015, 'Tailoring therapies-improving the management of early breast cancer: St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2015', Annals of Oncology, vol. 26, no. 8, pp. 1533-1546. https://doi.org/10.1093/annonc/mdv221
Coates, Alan S. ; Winer, Eric P. ; Goldhirsch, Aron ; Gelber, Richard D. ; Gnant, Michael ; Piccart-Gebhart, Martine J. ; Thürlimann, Beat ; Senn, H. J. ; André, Fabrice ; Baselga, José ; Bergh, Jonas ; Bonnefoi, Hervé ; Burstein, Harold ; Cardoso, Fatima ; Castiglione-Gertsch, Monica ; Colleoni, Marco ; Curigliano, Giuseppe ; Davidson, Nancy E. ; Leo, Angelo Di ; Ejlertsen, Bent ; Forbes, John F. ; Galimberti, Viviana ; Goodwin, Pamela ; Harbeck, Nadia ; Hayes, Daniel F. ; Huober, Jens ; Hudis, Clifford A. ; Ingle, James N. ; Jassem, Jacek ; Jiang, Zefei ; Karlsson, Per ; Morrow, Monica ; Orecchia, Roberto ; Kent Osborne, C. ; Partridge, Ann H. ; de la Peña, Lorena ; Pritchard, Kathleen I. ; Rutgers, Emiel J T ; Sedlmayer, Felix ; Semiglazov, Vladimir ; Shao, Zhi Ming ; Smith, Ian ; Toi, Masakazu ; Tutt, Andrew ; Viale, Giuseppe ; von Minckwitz, Gunter ; Watanabe, Toru ; Whelan, Timothy ; Xu, Binghe. / Tailoring therapies-improving the management of early breast cancer : St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2015. In: Annals of Oncology. 2015 ; Vol. 26, No. 8. pp. 1533-1546.
@article{d5d81cb35eb74836b225bf02805c23c9,
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.",
keywords = "Early breast cancer, Radiation therapy, St Gallen Consensus, Surgery, Systemic adjuvant therapies",
author = "Coates, {Alan S.} and Winer, {Eric P.} and Aron Goldhirsch and Gelber, {Richard D.} and Michael Gnant and Piccart-Gebhart, {Martine J.} and Beat Th{\"u}rlimann and Senn, {H. J.} and Fabrice Andr{\'e} and Jos{\'e} Baselga and Jonas Bergh and Herv{\'e} Bonnefoi and Harold Burstein and Fatima Cardoso and Monica Castiglione-Gertsch and Marco Colleoni and Giuseppe Curigliano and Davidson, {Nancy E.} and Leo, {Angelo Di} and Bent Ejlertsen and Forbes, {John F.} and Viviana Galimberti and Pamela Goodwin and Nadia Harbeck and Hayes, {Daniel F.} and Jens Huober and Hudis, {Clifford A.} and Ingle, {James N.} and Jacek Jassem and Zefei Jiang and Per Karlsson and Monica Morrow and Roberto Orecchia and {Kent Osborne}, C. and Partridge, {Ann H.} and {de la Pe{\~n}a}, Lorena and Pritchard, {Kathleen I.} and Rutgers, {Emiel J T} and Felix Sedlmayer and Vladimir Semiglazov and Shao, {Zhi Ming} and Ian Smith and Masakazu Toi and Andrew Tutt and Giuseppe Viale and {von Minckwitz}, Gunter and Toru Watanabe and Timothy Whelan and Binghe Xu",
year = "2015",
doi = "10.1093/annonc/mdv221",
language = "English (US)",
volume = "26",
pages = "1533--1546",
journal = "Annals of Oncology",
issn = "0923-7534",
publisher = "Oxford University Press",
number = "8",

}

TY - JOUR

T1 - Tailoring therapies-improving the management of early breast cancer

T2 - St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2015

AU - Coates, Alan S.

AU - Winer, Eric P.

AU - Goldhirsch, Aron

AU - Gelber, Richard D.

AU - Gnant, Michael

AU - Piccart-Gebhart, Martine J.

AU - Thürlimann, Beat

AU - Senn, H. J.

AU - André, Fabrice

AU - Baselga, José

AU - Bergh, Jonas

AU - Bonnefoi, Hervé

AU - Burstein, Harold

AU - Cardoso, Fatima

AU - Castiglione-Gertsch, Monica

AU - Colleoni, Marco

AU - Curigliano, Giuseppe

AU - Davidson, Nancy E.

AU - Leo, Angelo Di

AU - Ejlertsen, Bent

AU - Forbes, John F.

AU - Galimberti, Viviana

AU - Goodwin, Pamela

AU - Harbeck, Nadia

AU - Hayes, Daniel F.

AU - Huober, Jens

AU - Hudis, Clifford A.

AU - Ingle, James N.

AU - Jassem, Jacek

AU - Jiang, Zefei

AU - Karlsson, Per

AU - Morrow, Monica

AU - Orecchia, Roberto

AU - Kent Osborne, C.

AU - Partridge, Ann H.

AU - de la Peña, Lorena

AU - Pritchard, Kathleen I.

AU - Rutgers, Emiel J T

AU - Sedlmayer, Felix

AU - Semiglazov, Vladimir

AU - Shao, Zhi Ming

AU - Smith, Ian

AU - Toi, Masakazu

AU - Tutt, Andrew

AU - Viale, Giuseppe

AU - von Minckwitz, Gunter

AU - Watanabe, Toru

AU - Whelan, Timothy

AU - Xu, Binghe

PY - 2015

Y1 - 2015

N2 - 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.

AB - 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.

KW - Early breast cancer

KW - Radiation therapy

KW - St Gallen Consensus

KW - Surgery

KW - Systemic adjuvant therapies

UR - http://www.scopus.com/inward/record.url?scp=84939423024&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84939423024&partnerID=8YFLogxK

U2 - 10.1093/annonc/mdv221

DO - 10.1093/annonc/mdv221

M3 - Article

C2 - 25939896

AN - SCOPUS:84939423024

VL - 26

SP - 1533

EP - 1546

JO - Annals of Oncology

JF - Annals of Oncology

SN - 0923-7534

IS - 8

ER -