Annals of Oncology Advance Access published online on September 7, 2005
Annals of Oncology, doi:10.1093/annonc/mdi326
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1 International Breast Cancer Study Group, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; European Institute of Oncology, Milan, Italy
* To whom correspondence should be addressed. The ninth St Gallen (Switzerland) expert consensus meeting in January 2005 made a fundamental change in the algorithm for selection of adjuvant systemic therapy for early breast cancer. Rather than the earlier approach commencing with risk assessment, the Panel affirmed that the first consideration was endocrine responsiveness. Three categories were acknowledged: endocrine responsive, endocrine non-responsive and tumors of uncertain endocrine responsiveness. The three categories were further divided according to menopausal status. Only then did the Panel divide patients into low-, intermediate- and high-risk categories. It agreed that axillary lymph node involvement did not automatically define high risk. Intermediate risk included both node-negative disease (if some features of the primary tumor indicated elevated risk) and patients with one to three involved lymph nodes without additional high-risk features such as HER2/neu gene overexpression. The Panel recommended that patients be offered chemotherapy for endocrine non-responsive disease; endocrine therapy as the primary therapy for endocrine responsive disease, adding chemotherapy for some intermediate- and all high-risk groups in this category; and both chemotherapy and endocrine therapy for all patients in the uncertain endocrine response category except those in the low-risk group.
Review
Meeting Highlights: International Expert Consensus on the Primary Therapy of Early Breast Cancer 2005
2 Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA, USA
3 Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
4 The Cancer Council Australia and University of Sydney, Sydney, NSW, Australia
5 Division of Gynecologic Oncology, Kantonsspital, St Gallen, Switzerland
6 Zentrum für Tumordiagnostik und Prävention, Silberturm, Grossacker, St Gallen, Switzerland
A. Goldhirsch, E-mail: aron.goldhirsch{at}ibcsg.org
Abstract Panel Members are listed in the Appendix.
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