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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

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

Authors :
Bahadir M. Gulluoglu
A. Di Leo
Jonas Bergh
Jens Huober
Kent Osborne
Bo Xu
Beat Thürlimann
Chiun-Sheng Huang
Masakazu Toi
Eric P. Winer
Pamela J. Goodwin
Toshihiro Watanabe
Roberto Orecchia
Andrew Tutt
Ann H. Partridge
Nadia Harbeck
Felix Sedlmayer
Sara Y. Brucker
H.-J. Senn
José Baselga
Michael Gnant
Timothy J. Whelan
Jack Cuzick
Zefei Jiang
Zhimin Shao
Bent Ejlertsen
Emiel J. Th. Rutgers
Sibylle Loibl
Daniel F. Hayes
Meredith M. Regan
Jungsil Ro
Olivia Pagani
Prudence A. Francis
Vladimir Semiglazov
Judy Garber
Carsten Denkert
H. Khaled
Lisa A. Carey
Viviana Galimberti
Giuseppe Curigliano
Giuseppe Viale
I.E. Smith
Marco Colleoni
Monica Morrow
Harold J. Burstein
Eva Ciruelos
Hervé Bonnefoi
Per Karlsson
Fabrice Andre
Jacek Jassem
Martine Piccart-Gebhart
Peter Dubsky
Fatima Cardoso
Kathleen I. Pritchard
Curigliano, G.
Burstein, H. J.
Winer, E. P.
Gnant, M.
Dubsky, P.
Loibl, S.
Colleoni, M.
Regan, M. M.
Piccart-Gebhart, M.
Senn, H. -J.
Thurlimann, B.
Andre, F.
Baselga, J.
Bergh, J.
Bonnefoi, H.
Brucker, S. Y.
Cardoso, F.
Carey, L.
Ciruelos, E.
Cuzick, J.
Denkert, C.
Di Leo, A.
Ejlertsen, B.
Francis, P.
Galimberti, V.
Garber, J.
Gulluoglu, B.
Goodwin, P.
Harbeck, N.
Hayes, D. F.
Huang, C. -S.
Huober, J.
Khaled, H.
Jassem, J.
Jiang, Z.
Karlsson, P.
Morrow, M.
Orecchia, R.
Osborne, K. C.
Pagani, O.
Partridge, A. H.
Pritchard, K.
Ro, J.
Rutgers, E. J. T.
Sedlmayer, F.
Semiglazov, V.
Shao, Z.
Smith, I.
Toi, M.
Tutt, A.
Viale, G.
Watanabe, T.
Whelan, T. J.
Xu, B.
Source :
Repositorio Institucional de la Consejería de Sanidad de la Comunidad de Madrid, Consejería de Sanidad de la Comunidad de Madrid
Publication Year :
2017

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.

Details

Database :
OpenAIRE
Journal :
Repositorio Institucional de la Consejería de Sanidad de la Comunidad de Madrid, Consejería de Sanidad de la Comunidad de Madrid
Accession number :
edsair.doi.dedup.....9c7d9e0b333f5d730d36e5aad37a4ef4