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. 2017 Aug 1;28(8):1700-1712.
doi: 10.1093/annonc/mdx308.

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

G Curigliano #  1 , H J Burstein #  2 , E P Winer  2 , M Gnant  3 , P Dubsky  3   4 , S Loibl  5 , M Colleoni  1 , M M Regan  6 , M Piccart-Gebhart  7 , H-J Senn  8 , B Thürlimann  9 ; St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2017; F André  10 , J Baselga  11 , J Bergh  12 , H Bonnefoi  13 , S Y Brucker  14 , F Cardoso  15 , L Carey  16 , E Ciruelos  17 , J Cuzick  18 , C Denkert  19 , A Di Leo  20 , B Ejlertsen  21 , P Francis  22 , V Galimberti  1 , J Garber  2 , B Gulluoglu  23 , P Goodwin  24 , N Harbeck  25 , D F Hayes  26 , C-S Huang  27 , J Huober  28 , K Hussein  29 , J Jassem  30 , Z Jiang  31 , P Karlsson  32 , M Morrow  11 , R Orecchia  1 , K C Osborne  33 , O Pagani  34 , A H Partridge  2 , K Pritchard  35 , J Ro  36 , E J T Rutgers  37 , F Sedlmayer  38 , V Semiglazov  39 , Z Shao  40 , I Smith  41 , M Toi  42 , A Tutt  43 , G Viale  44   45 , T Watanabe  46 , T J Whelan  47 , B Xu  48
Affiliations

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

G Curigliano et al. Ann Oncol. .

Erratum in

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.

Keywords: St Gallen Consensus; early breast cancer; radiation therapy; surgery; systemic adjuvant therapies.

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Conflict of interest statement

J. Baselga is on the Board of Directors for Varian Medical Systems, Bristol-Myers Squibb, and is a past board member of Grail. He has performed consulting and/or advisory work for Roche, Lilly, and Novartis.

Comment in

References

    1. Burstein HJ, Polyak K, Wong JS. et al. Ductal carcinoma in situ of the breast. N Engl J Med 2004; 350: 1430–1441. - PubMed
    1. Wapnir IL, Dignam JJ, Fisher B. et al. Long-term outcome of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP-17 and B-24 randomized clinical trials for DCIS. J Natl Cancer Inst 2011; 103: 478–488. - PMC - PubMed
    1. Morrow M, Van Zee KJ, Solin LJ. et al. Society of Surgical Oncology-American Society for Radiation Oncology-American Society of Clinical Oncology Consensus Guideline on margins for breast-conserving surgery with whole-breast irradiation in ductal carcinoma in situ. J Clin Oncol 2016; 34: 4040–4046. - PMC - PubMed
    1. Forbes JF, Sestak I, Howell A. et al. Anastrozole versus tamoxifen for the prevention of locoregional and contralateral breast cancer in postmenopausal women with locally excised ductal carcinoma in situ (IBIS-II DCIS): a double-blind, randomised controlled trial. Lancet 2016; 387: 866–873. - PMC - PubMed
    1. Margolese RG, Cecchini RS, Julian TB. et al. Anastrozole versus tamoxifen in postmenopausal women with ductal carcinoma in situ undergoing lumpectomy plus radiotherapy (NSABP B-35): a randomised, double-blind, phase 3 clinical trial. Lancet 2016; 387: 849–856. - PMC - PubMed

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