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Annals of Oncology Advance Access published online on June 17, 2009
Annals of Oncology, doi:10.1093/annonc/mdp322
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© The Author 2009. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved.
The online version of this article has been published under an open access model. users are entitle to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that: the original authorship is properly and fully attributed; the Journal and the European Society for Medical Oncology are attributed as the original place of publication with the correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org

special article

Thresholds for therapies: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2009

A. Goldhirsch1,2,*, J. N. Ingle3, R. D. Gelber4, A. S. Coates5, B. Thürlimann6, H.-J. Senn7 and Panel members{dagger}

1 International Breast Cancer Study Group, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
2 European Institute of Oncology, Milan, Italy
3 Breast Cancer Research Program, Mayo Clinic Cancer Center, Rochester, MN, USA
4 Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
5 International Breast Cancer Study Group, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
6 Breast Center, Kantonsspital, St Gallen, Switzerland
7 Tumor and Breast Center ZeTuP, St Gallen, Switzerland

* Correspondence to: Prof. A. Goldhirsch, International Breast Cancer Study Group, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy. Tel: +39-02-57489439; Fax: +39-02-94379273; E-mail: aron.goldhirsch{at}ibcsg.org

The 11th St Gallen (Switzerland) expert consensus meeting on the primary treatment of early breast cancer in March 2009 maintained an emphasis on targeting adjuvant systemic therapies according to subgroups defined by predictive markers. Any positive level of estrogen receptor (ER) expression is considered sufficient to justify the use of endocrine adjuvant therapy in almost all patients. Overexpression or amplification of HER2 by standard criteria is an indication for anti-HER2 therapy for all but the very lowest risk invasive tumours. The corollary is that ER and HER2 must be reliably and accurately measured. Indications for cytotoxic adjuvant therapy were refined, acknowledging the role of risk factors with the caveat that risk per se is not a target. Proliferation markers, including those identified in multigene array analyses, were recognised as important in this regard. The threshold for indication of each systemic treatment modality thus depends on different criteria which have been separately listed to clarify the therapeutic decision-making algorithm.

early breast cancer, St Gallen Consensus, therapies

{dagger} See appendix for members of the Panel.

Received for publication May 12, 2009. Accepted for publication May 12, 2009.


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