Highlights of 10th St. Gallen Breast Cancer Conference: Systemic Adjuvant Treatment

Seung-Il Kim; Ho-yong Park

doi:10.4048/jbc.2007.10.1.1

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Kim and Park: Highlights of 10th St. Gallen Breast Cancer Conference: Systemic Adjuvant Treatment

Special Report

Journal of Breast Cancer

Journal of Breast Cancer 2007; 10(1): 1-9.

Published online: 31 March 2007

DOI: https://doi.org/10.4048/jbc.2007.10.1.1

Highlights of 10th St. Gallen Breast Cancer Conference: Systemic Adjuvant Treatment

Seung-Il Kim, Ho-yong Park¹

Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.

¹Department of Surgery, Kyungpook National University, College of Medicine, Daegu, Korea.

phy123@mail.knu.ac.kr

Abstract

The 10th St. Gallen International Conference- Primary Therapy of Early Breast Cancer was held in March 2007. The St. Gallen Conferences has focused on reaching expert consensus for patient treatment selection. Three categories were affirmed by responsiveness of endocrine treatment- endocrine responsive, endocrine responsive uncertain, endocrine non-responsive. Risk assessment will be similar than previous meeting (9th meeting) - low, intermediate, and high risk categories. The Panel recommended that patients be offered endocrine therapy or trastuzumab according to endocrine responsiveness or HER2 status. Chemotherapy offered to patients according to risk assessment. For patients with endocrine responsive and HER2 negative, selection of patient for chemotherapy is major challenge. The Panel of Expert attempted to answer many questions- endocrine therapy, chemotherapy, anti-HER2 therapy, and radiation therapy. This report focused on new information related to the best use of endocrine therapy and chemotherapy.

Keywords: St. Gallen conference 2007, Endocrine therapy, Chemotherapy

Figures and Tables

Fig 1

Trial types of adjuvant aromatase inhibitors.

^*: Combination arm was closed; ^†: Analysis was limited to patients on two monotherapy arms; ^‡: Combined results of ABCSG trial 8 and ARNO 95 trial; ^§: Study was unblinded to placebo arm on 30 month from randomization.

Fig 2

(A) MA 17 Post-Unblinding Cohorts, (B) Late extended adjuvant therapy- significant risk reduction across endpoint.

(A, B: Presented by Dr. Goss et al. 2006 ASCO, 2007 St. Gallen Conference).

Fig 3

Recurrence in the first 10 yr of follow up.

(Presented by Dr. Cuzick, St. Gallen 2007, Br J Cancer 2006;94:460-4).

Fig 4

Aromatase inhibitors- ongoning trials.

Fig 5

The impact of LHRH addition to chemotherapy on breast cancer recurrence and mortality: an overview of the randomized trials.

(Presented by Cuzick et al. SABCS 2006 & Presented by Davidson. St. Gallen Conference 2007).

Fig 6

Ongoing trials testing endocrine therapy for premenopausal women.

Fig 7

Adjuvant taxane therapy for women with early-stage, invasive breast cancer

Fig 8

Adjuvant trastuzumab trials.

Table 1

Choice of adjuvant treatments for breast cancer patients

^*: No data exist to dictate sequential or concurrent use of chemotherapy with aromatase inhibitors or ovarian function suppression/ablation; ^†: Trastuzumab should be added whose tumors show overexpression or amplification of HER2.

ET=endocrine therapy; CT=chemotherapy.

Table 2

Adjuvant treatment for 2×2 marker model of breast cancer - St. Gallen Conference 2007

^*: Selection of patient is major challenge.

Table 3

Efficacy of adjuvant aromatase inhibitors

^*Definition of disease free survival; ATAC: local & distant recurrence, new primary breast cancer, death from any cause; BIG 1-98: local, regional & distant recurrence, contralateral breast cancer, second non-breast cancer, death before recurrence; ABCSG/ARNO: local & distant recurrence, contralateral breast cancer; ITA: local, regional & distant recurrence; IES: local & distant recurrence, new primary breast cancer, death without recurrence; MA 17: breast, chest wall & nodal recurrence, metastases, contralateral breast cancer.

Table 4

Top ten breast cancer research questions by expert voting- St. Gallen Conference 2007

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