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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.

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Date
2017-08
ICR Author
Smith, Ian
Marsden,
Author
Curigliano, G
Burstein, HJ
Winer, EP
Gnant, M
Dubsky, P
Loibl, S
Colleoni, M
Regan, MM
Piccart-Gebhart, M
Senn, H-J
Thürlimann, B
St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2017
André, F
Baselga, J
Bergh, J
Bonnefoi, H
Brucker, SY
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, DF
Huang, C-S
Huober, J
Hussein, K
Jassem, J
Jiang, Z
Karlsson, P
Morrow, M
Orecchia, R
Osborne, KC
Pagani, O
Partridge, AH
Pritchard, K
Ro, J
Rutgers, EJT
Sedlmayer, F
Semiglazov, V
Shao, Z
Smith, I
Toi, M
Tutt, A
Viale, G
Watanabe, T
Whelan, TJ
Xu, B
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Type
Journal Article
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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.
URI
https://repository.icr.ac.uk/handle/internal/1218
DOI
https://doi.org/10.1093/annonc/mdx308
Collections
  • Clinical Studies
Subject
St. Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2017
Humans
Breast Neoplasms
Antineoplastic Agents
Adjuvants, Immunologic
Early Diagnosis
Combined Modality Therapy
Neoadjuvant Therapy
Radiotherapy
Surgical Procedures, Operative
Austria
Female
Research team
Medicine (RMH Smith Cunningham)
Language
eng
License start date
2017-08
Citation
Annals of oncology : official journal of the European Society for Medical Oncology, 2017, 28 (8), pp. 1700 - 1712

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