Skip to main content
SpringerLink
Log in

St. Gallen 2009 recommendations on the treatment of early breast cancer: consensus and controversy

  • Short Review
  • Published:
memo - Magazine of European Medical Oncology Aims and scope Submit manuscript

The 11th St. Gallen consensus meeting on the primary treatment of early breast cancer put a special emphasis on a tailored approach for patient subgroups, and by the selection of targetted treatments according to tumour biology. Sentinel node procedure was considered as the standard in invasive breast cancer with no clinical evidence of lymph node involvement. Concerning ductal carcinoma in situ (DCIS), the panellists voted for adjuvant radiotherapy to be considered standard for excised DCIS, but irradiation might be avoided in the elderly and in patients with low-grade DCIS. Accelerated whole breast radiotherapy was considered an acceptable optional after tumour excision, especially in patients above the age of 60 years. Furthermore, the panel supported validated multigene assays to be considered as an additional tool for choosing chemotherapy in endocrine-responsive disease. Concerning endocrine treatment, the panellists preferred upfront endocrine therapy with an aromatase inhibitor on the basis of the updated results of BIG 1-98, especially for cases with high risk of early recurrence. Changing the aromatase inhibitor to tamoxifen after 2 years of treatment was accepted as a treatment option. Finally, dose-dense doxorubicin/cyclophosphamide chemotherapy followed by paclitaxel, and docetaxel/cyclophosphamide were added to the group of standard adjuvant regimens.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Goldhirsch A, Ingle JN, Gelber RD, Coates AS, Thurlimann B and Senn HJ (2009). Thresholds for therapies: highlights of the St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2009. Ann Oncol 20(8): 1319–1329

    Article  CAS  PubMed  Google Scholar 

  2. Regan MM, Viale G, Mastropasqua MG, Maiorano E, Golouh R and Carbone A et al (2006). Re-evaluating adjuvant breast cancer trials: assessing hormone receptor status by immunohistochemical versus extraction assays. J Natl Cancer Inst 98(21): 1571–1581

    Article  CAS  PubMed  Google Scholar 

  3. Sorlie T, Perou CM, Tibshirani R, Aas T, Geisler S and Johnsen H et al (2001). Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci USA 98(19): 10869–10874

    Article  CAS  PubMed  Google Scholar 

  4. Goldhirsch A, Wood WC, Gelber RD, Coates AS, Thurlimann B, Senn HJ. Progress and promise: highlights of the international expert consensus on the primary therapy of early breast cancer 2007. Ann Oncol, 18(7): 1133–1144, 2007.

    Google Scholar 

  5. Kuerer HM, Albarracin CT, Yang WT, Cardiff RD, Brewster AM, Symmans WF, et al. Ductal carcinoma in situ: state of the science and roadmap to advance the field. J Clin Oncol, 27(2): 279–288, 2009.

    Google Scholar 

  6. Silverstein MJ (2003). The University of Southern California/Van Nuys prognostic index for ductal carcinoma in situ of the breast. Am J Surg 186(4): 337–343

    Article  PubMed  Google Scholar 

  7. Rashtian A, Iganej S, my Liu IL and Natarajan S (2008). Close or positive margins after mastectomy for DCIS: pattern of relapse and potential indications for radiotherapy. Int J Radiat Oncol Biol Phys 72(4): 1016–1020

    PubMed  Google Scholar 

  8. Fisher B, Land S, Mamounas E, Dignam J, Fisher ER, Wolmark N. Prevention of invasive breast cancer in women with ductal carcinoma in situ: an update of the National Surgical Adjuvant Breast and Bowel Project experience. Semin Oncol, 28(4): 400–418, 2001.

    Google Scholar 

  9. Bijker N, Meijnen P, Peterse JL, Bogaerts J, Van HI and Julien JP et al (2006). Breast-conserving treatment with or without radiotherapy in ductal carcinoma-in-situ: ten-year results of European Organisation for Research and Treatment of Cancer randomized phase III trial 10853 – a study by the EORTC Breast Cancer Cooperative Group and EORTC Radiotherapy Group. J Clin Oncol 24(21): 3381–3387

    Article  PubMed  Google Scholar 

  10. Antonucci JV, Wallace M, Goldstein NS, Kestin L, Chen P and Benitez P et al (2009). Differences in patterns of failure in patients treated with accelerated partial breast irradiation versus whole-breast irradiation: a matched-pair analysis with 10-year follow-up. Int J Radiat Oncol Biol Phys 74(2): 447–452

    PubMed  Google Scholar 

  11. Thor AD, Liu S, Moore DH and Edgerton SM (1999). Comparison of mitotic index in vitro bromodeoxyuridine labeling and MIB-1 assays to quantitate proliferation in breast cancer. J Clin Oncol 17(2): 470–477

    CAS  PubMed  Google Scholar 

  12. Trihia H, Murray S, Price K, Gelber RD, Golouh R, Goldhirsch A, et al. Ki-67 expression in breast carcinoma: its association with grading systems, clinical parameters, and other prognostic factors – a surrogate marker? Cancer, 97(5): 1321–1331, 2003.

  13. de AE, Cardoso F, Colozza M, Mano MS, Durbecq V and de CG et al (2007). Ki-67 as prognostic marker in early breast cancer: a meta-analysis of published studies involving 12,155 patients. Br J Cancer 96(10): 1504–1513

    Article  CAS  Google Scholar 

  14. Viale G, Regan MM, Maiorano E, Mastropasqua MG, Dell’Orto P and Rasmussen BB et al (2007). Prognostic and predictive value of centrally reviewed expression of estrogen and progesterone receptors in a randomized trial comparing letrozole and tamoxifen adjuvant therapy for postmenopausal early breast cancer: BIG 1-98. J Clin Oncol 25(25): 3846–3852

    Article  PubMed  Google Scholar 

  15. Cardoso F, Van’t VL, Rutgers E, Loi S, Mook S and Piccart-Gebhart MJ (2008). Clinical application of the 70-gene profile: the MINDACT trial. J Clin Oncol 26(5): 729–735

    Article  PubMed  Google Scholar 

  16. Sparano JA (2006). TAILORx: trial assigning individualized options for treatment (Rx). Clin Breast Cancer 7(4): 347–350

    Article  PubMed  Google Scholar 

  17. Cuzick J, Ambroisine L, Davidson N, Jakesz R, Kaufmann M, Regan M, et al. Use of luteinising-hormone-releasing hormone agonists as adjuvant treatment in premenopausal patients with hormone-receptor- positive breast cancer: a meta-analysis of individual patient data from randomised adjuvant trials. Lancet, 369(9574): 1711–1723, 2007.

    Google Scholar 

  18. Regan MM, Pagani O, Walley B, Torrisi R, Perez EA and Francis P et al (2008). Premenopausal endocrine-responsive early breast cancer: who receives chemotherapy? Ann Oncol 19(7): 1231–1241

    CAS  Google Scholar 

  19. Berry DA, Cirrincione C, Henderson IC, Citron ML, Budman DR and Goldstein LJ et al (2006). Estrogen-receptor status and outcomes of modern chemotherapy for patients with node-positive breast cancer. JAMA 295(14): 1658–1667

    Article  CAS  PubMed  Google Scholar 

  20. Early Breast CacnerTrialist’ Collaborative Group (2005). Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet 365(9472): 1687–1717

    Google Scholar 

  21. Thurlimann B, Price KN, Gelber RD, Holmberg SB, Crivellari D and Colleoni M et al (2009). Is chemotherapy necessary for premenopausal women with lower-risk node-positive, endocrine responsive breast cancer? 10-year update of International Breast Cancer Study Group Trial 11-93. Breast Cancer Res Treat 113(1): 137–144

    Article  PubMed  CAS  Google Scholar 

  22. Pritchard KI, Messersmith H, Elavathil L, Trudeau M, O’Malley F and Dhesy-Thind B (2008). HER-2 and topoisomerase II as predictors of response to chemotherapy. J Clin Oncol 26(5): 736–744

    Article  CAS  PubMed  Google Scholar 

  23. Senn JH, Thurlimann B. Proceedings of the 14th International Conference on Primary Therapy of Early Breast Cancer, March 11–14 2009, St.Gallen Switzerland. The Breast, 18(Suppl 3), 2009.

Download references

Author information

Authors and Affiliations

  1. Breast Center, Cantonal Hospital, Rorschacherstr. 95, CH-9007, St.Gallen, Switzerland

    M. Jörger & Beat Thürlimann MD

  2. Tumor- und Brustzentrum ZeTuP, St. Gallen, Switzerland

    H.-J. Senn

Authors
  1. M. Jörger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H.-J. Senn
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Beat Thürlimann MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Beat Thürlimann MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jörger, M., Senn, HJ. & Thürlimann, B. St. Gallen 2009 recommendations on the treatment of early breast cancer: consensus and controversy. memo 2, 229–231 (2009). https://doi.org/10.1007/s12254-009-0163-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12254-009-0163-1

Keywords

Search

Navigation