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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
- 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.
- Subjects :
- 0301 basic medicine
Oncology
medicine.medical_treatment
Systemic therapy
radiation therapy
Primary therapy
surgery
NEOADJUVANT CHEMOTHERAPY
DOUBLE-BLIND
0302 clinical medicine
Stage (cooking)
Neoadjuvant therapy
Early breast cancer
DISTANT RECURRENCE
Hematology
CONSERVING SURGERY
Corrigenda
Chemotherapy regimen
Combined Modality Therapy
Neoadjuvant Therapy
LYMPH-NODE BIOPSY
POSTMENOPAUSAL WOMEN
CARCINOMA IN-SITU
030220 oncology & carcinogenesis
Austria
Surgical Procedures, Operative
Special Articles
Female
medicine.medical_specialty
Antineoplastic Agents
Breast Neoplasms
systemic adjuvant therapies
03 medical and health sciences
Breast cancer
Adjuvants, Immunologic
Internal medicine
St Gallen Consensus
Adjuvant therapy
medicine
Humans
early breast cancer
ENDOCRINE THERAPY
Radiotherapy
business.industry
Carcinoma in situ
Cancer
Expert consensus
medicine.disease
Radiation therapy
030104 developmental biology
Annals
Early Diagnosis
AXILLARY DISSECTION
21-GENE RECURRENCE SCORE
business
Subjects
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