Here the abstract of the highlights of the International Expert Consensus on the Primary Therapy of Early BC 2007, from the current issue of the Annals of Oncology:
special article
Progress and promise: highlights of the international expert consensus on the primary therapy of early breast cancer 2007
A Goldhirsch1,*, WC Wood2, RD Gelber3, AS Coates4, B Thürlimann5, H-J Senn6 and Panel Members
1 International Breast Cancer Study Group, Oncology Institute of Southern Switzerland, 6500 Bellinzona, Switzerland and European Institute of Oncology, 20141 Milan, Italy
2 Department of Surgery, Emory University School of Medicine, N. E. Atlanta, GA 30322, USA
3 Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA 02115, USA
4 International Breast Cancer Study Group and University of Sydney, Sydney, NSW 2006, Australia
5 Division of Gynecologic Oncology, Kantonsspital, 9006 St Gallen, Switzerland
6 Tumor-Center ZeTuP (Detection, Treatment, Prevention), 9006 St Gallen, Switzerland
* Correspondence to: Dr A. Goldhirsch, International Breast Cancer Study Group, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy. E-mail: aron.goldhirsch@ibcsg.org
The 10
th St Gallen (Switzerland) expert consensus meeting in
March 2007 refined and extended a target-oriented approach to
adjuvant systemic therapy of early breast cancer. Target definition
is inextricably intertwined with the availability of target-specific
therapeutic agents. Since 2005, the presence of HER2 on the
cell surface has been used as an effective target for trastuzumab
much as steroid hormone receptors are targets for endocrine
therapies. An expert Panel reaffirmed the primary importance
of determining endocrine responsiveness of the cancer as a first
approach to selecting systemic therapy. Three categories were
acknowledged:
highly endocrine responsive, incompletely endocrine responsive and endocrine non-responsive. The Panel accepted
HER2-positivity to assign trastuzumab, and noted that adjuvant
trastuzumab has only been assessed together with chemotherapy.
They largely endorsed previous definitions of risk categories.
While recognizing the existence of several molecularly-based
tools for risk stratification, the Panel preferred to recommend
the use of high-quality standard histopathological assessment
for both risk allocation and target identification. Chemotherapy,
although largely lacking specific target information, is the
only option in cases which are both endocrine receptor-negative
and HER2-negative. Chemotherapy is conventionally given with
or preceding trastuzumab for patients with HER2-positive disease,
and may be used for patients with endocrine responsive disease
in cases where the sufficiency of endocrine therapy alone is
uncertain. Recommendations are provided not as specific therapy
guidelines but rather as a general guidance emphasizing main
principles for tailoring therapeutic choice.
See Appendix for members of the Panel.
Received for publication April 30, 2007. Accepted for publication May 2, 2007.
link:
http://annonc.oxfordjournals.org/cgi...ract/18/7/1133
Hopeful