Meeting H ighlights: U pdated I nternational E xpert C onsensus on t he P rimary T herapy o f E arly B reast C ancer

This account of the highlights of the eighth St Gallen (Switzerland) meeting in 2003 emphasizes new in- formation that has emerged during the 2 years since the seventh meeting in 2001. This article should be read in conjunction with the report of that earlier meeting. Recom- mendations for patient care are so critically dependent on assessment of endocrine responsiveness that the impor- tance of high-quality steroid hormone receptor determina- tion and standardized quantitative reporting cannot be overemphasized. The International Consensus Panel modi- fied the risk categories so that only endocrine receptor- absent status was sufficient to reclassify an otherwise low- risk, node-negative disease into the category of average risk. Absence of steroid hormone receptors also was recog- nized as indicating endocrine nonresponsiveness. Some im- portant areas highlighted at the recent meeting include: (1) recognition of the separate nature of endocrine-nonre- sponsive breast cancer—both invasive cancers and ductal carcinoma-in-situ; (2) improved understanding of the mech- anisms of acquired endocrine resistance, which offer excit- ing prospects for extending the impact of successful sequen- tial endocrine therapies; (3) presentation of high-quality evidence indicating that chemotherapy and tamoxifen should be used sequentially rather than concurrently; (4) availability of a potential alternative to tamoxifen for treatment of postmenopausal women with endocrine-re- sponsive disease; and (5) the promise of newly defined prognostic and predictive markers. J Clin Oncol 21:3357-3365. © 2003 by American Society of Clinical Oncology. D EVELOPMENT OF expert consensus treatment guidelines for early breast cancer requires comprehensive analysis of the results of randomized clinical trials and the interpretation of their biologic, clinical, social, and personal relevance for indi- vidual patients. The series of conferences held in St Gallen (Switzerland) since 1978 has specifically focused on reaching expert consensus on the implications of evidence for patient treatment selection. 1 The eighth such meeting, with 3,200