Originally published as JCO Early Release 10.1200/JCO.2003.04.576 on July 7 2003
Journal of Clinical Oncology, Vol 21, Issue 17
(September), 2003: 3357-3365
© 2003 American Society for Clinical Oncology
Meeting Highlights: Updated International Expert Consensus on the Primary Therapy of Early Breast Cancer
Aron Goldhirsch,
William C. Wood,
Richard D. Gelber,
Alan S. Coates,
Beat Thürlimann,
Hans-Jörg Senn
From the International Breast Cancer Study Group, Oncology Institute of Southern Switzerland, Lugano; Division of Gynecologic Oncology, Kantonsspital; Zentrum für Tumordiagnostik und Prävention, Silberturm, Grossacker, St Gallen, Switzerland; European Institute of Oncology, Milan, Italy; Department of Surgery, Emory University, Atlanta, GA; Department of Biostatistical Science, Dana-Farber Cancer Institute, Boston, MA; and The Cancer Council Australia, Sydney, New South Wales, Australia.
Address reprint requests to Aron Goldhirsch, MD, International Breast Cancer Study Group, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy; e-mail: agoldhirsch{at}sakk.ch.
This account of the highlights of the eighth St Gallen (Switzerland) meeting in 2003 emphasizes new information 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. Recommendations for patient care are so critically dependent on assessment of endocrine responsiveness that the importance of high-quality steroid hormone receptor determination and standardized quantitative reporting cannot be overemphasized. The International Consensus Panel modified the risk categories so that only endocrine receptorabsent 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 recognized as indicating endocrine nonresponsiveness. Some important areas highlighted at the recent meeting include: (1) recognition of the separate nature of endocrine-nonresponsive breast cancerboth invasive cancers and ductal carcinoma-in-situ; (2) improved understanding of the mechanisms of acquired endocrine resistance, which offer exciting prospects for extending the impact of successful sequential 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-responsive disease; and (5) the promise of newly defined prognostic and predictive markers.
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