Thresholds for therapies: highlights of the St Gallen International Expert Consensus on the primary therapy of early breast cancer 2009

A Goldhirsch, J N Ingle, R D Gelber, A S Coates, B Thürlimann, H-J Senn, Panel members, Matti Aapro, Kathy S Albain, Jonas Bergh, Harold Burstein, Robert Carlson, Monica Castiglione-Gertsch, Alan S Coates, Marco Colleoni, Alberto Costa, Jack Cuzick, Nancy Davidson, Angelo Di Leo, John F Forbes, Richard D Gelber, John H Glick, Joseph Gligorov, Michael Gnant, Aaron Goldhirsch, Paul E Goss, Jay Harris, James N Ingle, Jacek Jassem, Per Karlsson, Manfred Kaufmann, Stella Kyriakides, Louis Mauriac, Gunter von Minckwitz, Monica Morrow, Henning T Mouridsen, Moise Namer, Larry Norton, Soonmyung Paik, Martine J Piccart-Gebhart, Kurt Possinger, Kathleen I Pritchard, Emiel J T Rutgers, Vladimir F Semiglazov, Ian Smith, Beat Thürlimann, Giuseppe Viale, Toru Watanabe, Eric P Winer, William C Wood, A Goldhirsch, J N Ingle, R D Gelber, A S Coates, B Thürlimann, H-J Senn, Panel members, Matti Aapro, Kathy S Albain, Jonas Bergh, Harold Burstein, Robert Carlson, Monica Castiglione-Gertsch, Alan S Coates, Marco Colleoni, Alberto Costa, Jack Cuzick, Nancy Davidson, Angelo Di Leo, John F Forbes, Richard D Gelber, John H Glick, Joseph Gligorov, Michael Gnant, Aaron Goldhirsch, Paul E Goss, Jay Harris, James N Ingle, Jacek Jassem, Per Karlsson, Manfred Kaufmann, Stella Kyriakides, Louis Mauriac, Gunter von Minckwitz, Monica Morrow, Henning T Mouridsen, Moise Namer, Larry Norton, Soonmyung Paik, Martine J Piccart-Gebhart, Kurt Possinger, Kathleen I Pritchard, Emiel J T Rutgers, Vladimir F Semiglazov, Ian Smith, Beat Thürlimann, Giuseppe Viale, Toru Watanabe, Eric P Winer, William C Wood

Abstract

The 11(th) 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.

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