jueves, 15 de julio de 2010

Thresholds for therapies: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2009 — Ann Oncol


Thresholds for therapies: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2009
A. Goldhirsch1,2,*, J. N. Ingle3, R. D. Gelber4, A. S. Coates5, B. Thürlimann6, H.-J. Senn7 and Panel members†


+ Author Affiliations
1International Breast Cancer Study Group, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
2European Institute of Oncology, Milan, Italy
3Breast Cancer Research Program, Mayo Clinic Cancer Center, Rochester, MN, USA
4Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA, USA
5International Breast Cancer Study Group, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
6Breast Center, Kantonsspital, St Gallen, Switzerland
7Tumor and Breast Center ZeTuP, St Gallen, Switzerland

*Correspondence to: Prof. A. Goldhirsch, International Breast Cancer Study Group, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy.
Tel: +39-02-57489439 begin_of_the_skype_highlighting
+39-02-57489439 end_of_the_skype_highlighting;
Fax: +39-02-94379273;
E-mail: aron.goldhirsch@ibcsg.org
Received May 12, 2009.
Accepted May 12, 2009.

Abstract
The 11th 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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Thresholds for therapies: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2009 — Ann Oncol

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