Her2 Lanús Editado

Annals of Oncology Advance Access published June 27, 2011

special article

Annals of Oncology doi:10.1093/annonc/mdr304

Strategies for subtypes—dealing with the diversity of breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011
A. Goldhirsch1,*, W. C. Wood2, A. S. Coates3, R. D. Gelber4, B. Thurlimann5, H.-J. Senn6 &Panel ¨   members
International Breast Cancer Study Group, Department of Medicine, European Institute of Oncology, Milan, Italy; 2Department of Surgery, Emory University School of Medicine, N. E. Atlanta, USA; 3International Breast Cancer Study Group and University of Sydney, Sydney, Australia; 4International Breast Cancer Study Group Statistical Center, Department of Biostatistics andComputational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA; 5Breast Center, Kantonsspital St Gallen, St Gallen; 6Tumor and Breast Center ZeTuP, St Gallen, Switzerland
1

Received 21 April 2011; accepted 23 May 2011

The 12th St Gallen International Breast Cancer Conference (2011) Expert Panel adopted a new approach to the classification of patients for therapeutic purposesbased on the recognition of intrinsic biological subtypes within the breast cancer spectrum. For practical purposes, these subtypes may be approximated using clinicopathological rather than gene expression array criteria. In general, systemic therapy recommendations follow the subtype classification. Thus, ‘Luminal A’ disease generally requires only endocrine therapy, which also forms part of thetreatment of the ‘Luminal B’ subtype. Chemotherapy is considered indicated for most patients with ‘Luminal B’, ‘Human Epidermal growth factor Receptor 2 (HER2) positive’, and ‘Triple negative (ductal)’ disease, with the addition of trastuzumab in ‘HER2 positive’ disease. Progress was also noted in defining better tolerated local therapies in selected cases without loss of efficacy, such asaccelerated radiation therapy and the omission of axillary dissection under defined circumstances. Broad treatment recommendations are presented, recognizing that detailed treatment decisions need to consider disease extent, host factors, patient preferences, and social and economic constraints. Key words: adjuvant therapies, early breast cancer, St Gallen Consensus, subtypes

introduction
It is no longertenable to consider breast cancer as a single disease. Subtypes can be defined by genetic array testing [1–3] or approximations to this classification using immunohistochemistry [4–7]. These subtypes have different epidemiological risk factors [8, 9], different natural histories [10–12], and different responses to systemic and local therapies [13–17]. These differences imply that cliniciansmanaging breast cancer should consider cases within the various distinct subtypes in order to properly assess the relevant evidence and arrive at appropriate therapeutic advice.

St Gallen 2011: news and progress
The 12th International Breast Cancer Conference in March 2011 brought together some 4300 participants from 96
*Correspondence to: Prof. A. Goldhirsch, International Breast Cancer StudyGroup, Department of Medicine, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy. Tel: +39-02-57489439; Fax: +39-02-94379273; E-mail: aron.goldhirsch@ibcsg.org;
 

See Appendix 1 for members of the Panel.

countries and a worldwide faculty representing all relevant disciplines. After presentation of recent research findings, a 51-member Expert Panel (see Appendix 1) considered anumber of questions in order to arrive at treatment recommendations for the immediate future. As in previous St Gallen conferences [18], the Panel was charged with assessing the evidence, but also advising on the basis of expert opinion on those questions where the evidence was ambiguous or lacking. For the first time, this conference included an explicit approach to management of conflicts of...