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

被引：1014

作者：

Curigliano, G. ^{[1
]}

Burstein, H. J. ^{[2
]}

Winer, E. P. ^{[2
]}

Gnant, M. ^{[3
]}

Dubsky, P. ^{[3
,4
]}

Loibl, S. ^{[5
]}

Colleoni, M. ^{[1
]}

Regan, M. M. ^{[6
]}

Piccart-Gebhart, M. ^{[7
]}

Senn, H. -J. ^{[8
]}

Thurlimann, B. ^{[9
]}

Andre, F. ^{[10
]}

Baselga, J. ^{[11
]}

Bergh, J. ^{[12
]}

Bonnefoi, H. ^{[13
]}

Brucker, S. Y. ^{[14
]}

Cardoso, F. ^{[15
]}

Carey, L. ^{[16
]}

Ciruelos, E. ^{[17
]}

Cuzick, J. ^{[18
]}

Denkert, C. ^{[19
]}

Di Leo, A. ^{[20
]}

Ejlertsen, B. ^{[21
]}

Francis, P. ^{[22
]}

Galimberti, V. ^{[1
]}

Garber, J. ^{[2
]}

Gulluoglu, B. ^{[23
]}

Goodwin, P. ^{[24
]}

Harbeck, N. ^{[25
]}

Hayes, D. F. ^{[26
]}

Huang, C. -S. ^{[27
]}

Huober, J. ^{[28
]}

Khaled, H. ^{[29
]}

Jassem, J. ^{[30
]}

Jiang, Z. ^{[31
]}

Karlsson, P. ^{[32
,35
]}

Morrow, M. ^{[10
]}

Orecchia, R. ^{[1
]}

Osborne, K. C. ^{[33
]}

Pagani, O. ^{[34
]}

Partridge, A. H. ^{[2
]}

Pritchard, K.

Ro, J. ^{[36
]}

Rutgers, E. J. T. ^{[37
]}

Sedlmayer, F. ^{[38
]}

Semiglazov, V. ^{[39
]}

Shao, Z. ^{[40
]}

Smith, I. ^{[41
]}

Toi, M. ^{[42
]}

Tutt, A. ^{[43
]}

机构：

[1] Ist Europeo Oncol, Breast Canc Program, Milan, Italy

[2] Harvard Med Sch, Dana Farber Canc Inst, Breast Oncol Ctr, Boston, MA USA

[3] Med Univ Vienna, Comprehens Canc Ctr Vienna, Dept Surg, Vienna, Austria

[4] Klin St Anna, Luzern, Switzerland

[5] German Breast Grp, Neu Isenburg, Germany

[6] Harvard Med Sch, Dana Farber Canc Inst, Dept Biostat & Computat Biol, Boston, MA USA

[7] Univ Libre Bruxelles, Inst Jules Bordet, Dept Med Oncol, Brussels, Belgium

[8] Tumor & Breast Ctr ZeTuP, St Gallen, Switzerland

[9] Kantonsspital St Gallen, Breast Ctr, St Gallen, Switzerland

[10] Inst Cancerol Gustave Roussy, Villejuif, France

[11] Mem Sloan Kettering Canc Ctr, 1275 York Ave, New York, NY 10021 USA

[12] Karolinska Inst & Univ Hosp, Stockholm, Sweden

[13] Univ Bordeaux, Bordeaux, France

[14] Univ Frauenklin Tubingen, Tubingen, Germany

[15] Champalimaud Canc Ctr, Lisbon, Portugal

[16] Univ N Carolina, Lineberger Comprehens Canc Ctr, Chapel Hill, NC 27599 USA

[17] Hosp Univ 12 Octubre, Madrid, Spain

[18] Queen Mary Univ London, Wolfson Inst Prevent Med, Ctr Canc Prevent, London, England

[19] Charite, Inst Pathol, Berlin, Germany

[20] Azienda Usl Toscana Ctr, Prato, Italy

[21] Rigshosp, Copenhagen, Denmark

[22] Peter MacCallum Canc Ctr, Melbourne, Australia

[23] Marmara Univ, Sch Med, Istanbul, Turkey

[24] Univ Toronto, Mt Sinai Hosp, Toronto, ON, Canada

[25] Univ Munich, Marchioninistr 15, D-81377 Munich, Germany

[26] Univ Michigan, Ctr Comprehens Canc, Ann Arbor, MI 48109 USA

[27] Natl Taiwan Univ Hosp, Taipei, Taiwan

[28] Univ Ulm, D-89069 Ulm, Germany

[29] Cairo Univ, Natl Canc Inst, Cairo, Egypt

[30] Med Univ Gdansk, Gdansk, Poland

[31] Hosp Affiliated Mil Med Sci, Beijing, Peoples R China

[32] Sahlgrensky Univ Hosp, Sahlgrenska Acad, Inst Clin Sci, Gothenburg, Sweden

[33] Baylor Coll Med, Houston, TX 77030 USA

[34] Osped San Giovanni Bellinzona, Inst Oncol Southern Switzerland, Bellinzona, Switzerland

[35] Univ Toronto, Sunnybrook Odette Canc Ctr, Toronto, ON, Canada

[36] Natl Canc Ctr, Goyang Si, Gyeonggi Do, South Korea

[37] Antoni Van Leeuwenhoek Hosp, Netherlands Canc Inst, Amsterdam, Netherlands

[38] Paracelsus Med Univ Clin, LKH Salzburg, Salzburg, Austria

[39] N N Petrov Res Inst Oncol, St Petersburg, Russia

[40] Fudan Univ, Canc Hosp, Shanghai, Peoples R China

[41] Royal Marsden, Sutton, Surrey, England

[42] Kyoto Univ, Graduate Sch Med, Sakyo Ku, Kyoto, Japan

[43] Inst Canc Res, Breast Canc Now Res Ctr, London, England

[44] Univ Milan, Milan, Italy

[45] Ist Europeo Oncol, Milan, Italy

[46] Hamamatsu Oncol Ctr, Hamamatsu, Shizuoka, Japan

[47] McMaster Univ, Hamilton, ON, Canada

[48] Natl Canc Ctr, Beijing, Peoples R China

来源：

ANNALS OF ONCOLOGY | 2017年 / 28卷 / 08期

关键词：

St Gallen Consensus; early breast cancer; radiation therapy; surgery; systemic adjuvant therapies; CARCINOMA IN-SITU; 21-GENE RECURRENCE SCORE; LYMPH-NODE BIOPSY; NEOADJUVANT CHEMOTHERAPY; DOUBLE-BLIND; POSTMENOPAUSAL WOMEN; AXILLARY DISSECTION; CONSERVING SURGERY; DISTANT RECURRENCE; ENDOCRINE THERAPY;

D O I：

10.1093/annonc/mdx308

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 [肿瘤学];

摘要：

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.

引用

页码：1700 / 1712

页数：13

共 91 条

[1]

Phase Ib trial of atezolizumab in combination with nab-paclitaxel in patients with metastatic triple negative breast cancer (mTNBC). [J].

Adams, Sylvia ;

Diamond, Jennifer Robinson ;

Hamilton, Erika Paige ;

Pohlmann, Paula Raffin ;

Tolaney, Sara M. ;

Molinero, Luciana ;

He, Xian ;

Waterkamp, Daniel ;

Funke, Roel Peter ;

Powderly, John D. .

JOURNAL OF CLINICAL ONCOLOGY, 2016, 34 (15)

[2]

Comparisons between different polychemotherapy regimens for early breast cancer: meta-analyses of long-term outcome among 100 000 women in 123 randomised trials [J].

Albain, K. ;

Anderson, S. ;

Arriagada, R. ;

Barlow, W. ;

Bergh, J. ;

Bliss, J. ;

Buyse, M. ;

Cameron, D. ;

Carrasco, E. ;

Clarke, M. ;

Correa, C. ;

Coates, A. ;

Collins, R. ;

Costantino, J. ;

Cutter, D. ;

Cuzick, J. ;

Darby, S. ;

Davidson, N. ;

Davies, C. ;

Davies, K. ;

Delmestri, A. ;

Di Leo, A. ;

Dowsett, M. ;

Elphinstone, P. ;

Evans, V. ;

Ewertz, M. ;

Gelber, R. ;

Gettins, L. ;

Geyer, C. ;

Goldhirsch, A. ;

Godwin, J. ;

Gray, R. ;

Gregory, C. ;

Hayes, D. ;

Hill, C. ;

Ingle, J. ;

Jakesz, R. ;

James, S. ;

Kaufmann, M. ;

Kerr, A. ;

MacKinnon, E. ;

McGale, P. ;

McHugh, T. ;

Norton, L. ;

Ohashi, Y. ;

Paik, S. ;

Pan, H. C. ;

Perez, E. ;

Peto, R. ;

Piccart, M. .

LANCET, 2012, 379 (9814) :432-444

[3]