Treatment of Early Breast Cancer Patients: Evidence, Controversies, Consensus: Focusing on Systemic Therapy – German Experts’ Opinions for the 16th International St. Gallen Consensus Conference (Vienna 2019)

A German working group of leading breast cancer experts have discussed the votes at the International St. Gallen Consensus Conference in Vienna for the treatment of primary breast cancer with regard to the German AGO (Arbeitsgemeinschaft Gynäkologische Onkologie) recommendations for clinical practice in Germany. Three of the German breast cancer experts were also members of this year’s St. Gallen panel. Comparing the St. Gallen recommendations with the annually updated treatment recommendations of the Gynecological Oncology Working Group (AGO Mamma 2019) and the German S3 Guideline is useful, because the recommendations of the St. Gallen panel are based on expert opinions of different countries and disciplines. The focus of this article is on systemic therapy. The motto of this year’s 16th St. Gallen Consensus Conference was “Estimating the magnitude of clinical benefit.” The rationale behind this motto is that, for every treatment decision, a benefit-risk assessment must be taken into consideration for each patient.

[1]  M. Lux,et al.  AGO Recommendations for the Diagnosis and Treatment of Patients with Early Breast Cancer: Update 2019 , 2019, Breast Care.

[2]  P. Fasching,et al.  Primary Therapy of Early Breast Cancer: Evidence, Controversies, Consensus , 2019, Geburtshilfe und Frauenheilkunde.

[3]  Nadia Harbeck,et al.  St. Gallen/Vienna 2019: A Brief Summary of the Consensus Discussion on the Optimal Primary Breast Cancer Treatment , 2019, Breast Care.

[4]  S. O'Reilly,et al.  Atezolizumab and Nab-Paclitaxel in Advanced Triple-Negative Breast Cancer. , 2019, The New England journal of medicine.

[5]  R. Greil,et al.  Adjuvant denosumab in postmenopausal patients with hormone receptor-positive breast cancer (ABCSG-18): disease-free survival results from a randomised, double-blind, placebo-controlled, phase 3 trial. , 2019, The Lancet. Oncology.

[6]  S. Shak,et al.  West German Study PlanB Trial: Adjuvant Four Cycles of Epirubicin and Cyclophosphamide Plus Docetaxel Versus Six Cycles of Docetaxel and Cyclophosphamide in HER2-Negative Early Breast Cancer. , 2019, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[7]  P. Fasching,et al.  Trastuzumab Emtansine for Residual Invasive HER2‐Positive Breast Cancer , 2019, The New England journal of medicine.

[8]  C. Liedtke,et al.  AGO Recommendations for the Diagnosis and Treatment of Patients with Early Breast Cancer: Update 2018 , 2018, Breast Care.

[9]  H. Iwata,et al.  Adjuvant denosumab in early breast cancer: First results from the international multicenter randomized phase III placebo controlled D-CARE study. , 2018 .

[10]  W. Symmans,et al.  Addition of the PARP inhibitor veliparib plus carboplatin or carboplatin alone to standard neoadjuvant chemotherapy in triple-negative breast cancer (BrighTNess): a randomised, phase 3 trial. , 2018, The Lancet. Oncology.

[11]  Sung-Bae Kim,et al.  Neratinib after trastuzumab-based adjuvant therapy in HER2-positive breast cancer (ExteNET): 5-year analysis of a randomised, double-blind, placebo-controlled, phase 3 trial. , 2017, The Lancet. Oncology.

[12]  P. Fasching,et al.  Germline Mutation Status, Pathological Complete Response, and Disease-Free Survival in Triple-Negative Breast Cancer: Secondary Analysis of the GeparSixto Randomized Clinical Trial , 2017, JAMA oncology.

[13]  L. Rubinstein,et al.  CREATE-X a role for capecitabine in early-stage breast cancer: an analysis of available data , 2017, npj Breast Cancer.

[14]  Sung-Bae Kim,et al.  Adjuvant Capecitabine for Breast Cancer after Preoperative Chemotherapy , 2017, The New England journal of medicine.

[15]  S. Shak,et al.  West German Study Group Phase III PlanB Trial: First Prospective Outcome Data for the 21-Gene Recurrence Score Assay and Concordance of Prognostic Markers by Central and Local Pathology Assessment. , 2016, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[16]  L. V. van't Veer,et al.  70-Gene Signature as an Aid to Treatment Decisions in Early-Stage Breast Cancer. , 2016, The New England journal of medicine.

[17]  C. Liedtke,et al.  AGO Recommendations for the Diagnosis and Treatment of Patients with Early Breast Cancer: Update 2016 , 2016, Breast Care.

[18]  Virginia G Kaklamani,et al.  Prospective Validation of a 21-Gene Expression Assay in Breast Cancer. , 2015, The New England journal of medicine.

[19]  E. Rutgers,et al.  Adjuvant bisphosphonate treatment in early breast cancer: meta-analyses of individual patient data from randomised trials , 2015, The Lancet.

[20]  R. Greil,et al.  Adjuvant denosumab in breast cancer (ABCSG-18): a multicentre, randomised, double-blind, placebo-controlled trial , 2015, The Lancet.

[21]  E. Perez,et al.  Long-Term Follow-Up of the E1199 Phase III Trial Evaluating the Role of Taxane and Schedule in Operable Breast Cancer. , 2015, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[22]  M. Regan,et al.  Exemestane with ovarian suppression in premenopausal breast cancer. , 2014, The New England journal of medicine.

[23]  S. Barni,et al.  The value of platinum agents as neoadjuvant chemotherapy in triple-negative breast cancers: a systematic review and meta-analysis , 2014, Breast Cancer Research and Treatment.

[24]  R. Chlebowski,et al.  Exemestane with ovarian suppression in premenopausal breast cancer. , 2014, The New England journal of medicine.

[25]  R. Greil,et al.  Adjuvant endocrine therapy plus zoledronic acid in premenopausal women with early-stage breast cancer: 62-month follow-up from the ABCSG-12 randomised trial. , 2011, The Lancet. Oncology.