Originally published as JCO Early Release 10.1200/JCO.2003.04.576 on July 7 2003

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Meeting Highlights: Updated International Expert Consensus on the Primary Therapy of Early Breast Cancer

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 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 recognized as indicating endocrine nonresponsiveness. Some important areas highlighted at the recent meeting include: (1) recognition of the separate nature of endocrine-nonresponsive breast cancer—both 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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				T Nagahata, T Sato, A Tomura, M Onda, K Nishikawa, and M Emi Identification of RAI3 as a therapeutic target for breast cancer Endocr. Relat. Cancer, March 1, 2005; 12(1): 65 - 73. [Abstract] [Full Text] [PDF]

				M. Colleoni, N. Rotmensz, G. Peruzzotti, P. Maisonneuve, G. Mazzarol, G. Pruneri, A. Luini, M. Intra, P. Veronesi, V. Galimberti, et al. Size of Breast Cancer Metastases in Axillary Lymph Nodes: Clinical Relevance of Minimal Lymph Node Involvement J. Clin. Oncol., March 1, 2005; 23(7): 1379 - 1389. [Abstract] [Full Text] [PDF]

				M. Colleoni, D. Zahrieh, R. D. Gelber, S. B. Holmberg, J. E. Mattsson, C.-M. Rudenstam, J. Lindtner, D. Erzen, R. Snyder, J. Collins, et al. Site of Primary Tumor Has a Prognostic Role in Operable Breast Cancer: The International Breast Cancer Study Group Experience J. Clin. Oncol., March 1, 2005; 23(7): 1390 - 1400. [Abstract] [Full Text] [PDF]

				U. Veronesi, R. Orecchia, S. Zurrida, V. Galimberti, A. Luini, P. Veronesi, G. Gatti, G. D'Aiuto, L. Cataliotti, R. Paolucci, et al. Avoiding axillary dissection in breast cancer surgery: a randomized trial to assess the role of axillary radiotherapy Ann. Onc., March 1, 2005; 16(3): 383 - 388. [Abstract] [Full Text] [PDF]

				M. Filipits, G. Pohl, M. Rudas, O. Dietze, S. Lax, R. Grill, R. Pirker, C. C. Zielinski, H. Hausmaninger, E. Kubista, et al. Clinical Role of Multidrug Resistance Protein 1 Expression in Chemotherapy Resistance in Early-Stage Breast Cancer: The Austrian Breast and Colorectal Cancer Study Group J. Clin. Oncol., February 20, 2005; 23(6): 1161 - 1168. [Abstract] [Full Text] [PDF]

				J. N. Ingle Endocrine Therapy Trials of Aromatase Inhibitors for Breast Cancer in the Adjuvant and Prevention Settings Clin. Cancer Res., January 15, 2005; 11(2): 900s - 905s. [Abstract] [Full Text] [PDF]

				R. C. Bast Jr. and G. N. Hortobagyi Individualized Care for Patients with Cancer -- A Work in Progress N. Engl. J. Med., December 30, 2004; 351(27): 2865 - 2867. [Full Text] [PDF]

				International Breast Cancer Study Group Toremifene and tamoxifen are equally effective for early-stage breast cancer: first results of International Breast Cancer Study Group Trials 12-93 and 14-93 Ann. Onc., December 1, 2004; 15(12): 1749 - 1759. [Abstract] [Full Text] [PDF]

				P. Fargeot, J. Bonneterre, H. Roche, A. Lortholary, M. Campone, I. Van Praagh, A. Monnier, M. Namer, S. Schraub, J.-C. Barats, et al. Disease-Free Survival Advantage of Weekly Epirubicin Plus Tamoxifen Versus Tamoxifen Alone As Adjuvant Treatment of Operable, Node-Positive, Elderly Breast Cancer Patients: 6-Year Follow-Up Results of the French Adjuvant Study Group 08 Trial J. Clin. Oncol., December 1, 2004; 22(23): 4674 - 4682. [Abstract] [Full Text] [PDF]

				M. Colleoni, N. Rotmensz, G. Peruzzotti, P. Maisonneuve, G. Viale, G. Renne, C. Casadio, P. Veronesi, M. Intra, R. Torrisi, et al. Minimal and small size invasive breast cancer with no axillary lymph node involvement: the need for tailored adjuvant therapies Ann. Onc., November 1, 2004; 15(11): 1633 - 1639. [Abstract] [Full Text] [PDF]

				G. Viale An Alternative Viewpoint International Journal of Surgical Pathology, October 1, 2004; 12(4): 307 - 309. [PDF]

				M. Colleoni, G. Viale, D. Zahrieh, G. Pruneri, O. Gentilini, P. Veronesi, R. D. Gelber, G. Curigliano, R. Torrisi, A. Luini, et al. Chemotherapy Is More Effective in Patients with Breast Cancer Not Expressing Steroid Hormone Receptors: A Study of Preoperative Treatment Clin. Cancer Res., October 1, 2004; 10(19): 6622 - 6628. [Abstract] [Full Text] [PDF]

				R. M. O'Regan Do Tumors Detected by Mammography Screening Have a Favorable Prognosis? JAMA, September 1, 2004; 292(9): 1062 - 1063. [Full Text] [PDF]

				T. M. Prowell and N. E. Davidson What Is the Role of Ovarian Ablation in the Management of Primary and Metastatic Breast Cancer Today? Oncologist, September 1, 2004; 9(5): 507 - 517. [Abstract] [Full Text] [PDF]

				R. C. Coombes, E. Hall, L. J. Gibson, R. Paridaens, J. Jassem, T. Delozier, S. E. Jones, I. Alvarez, G. Bertelli, O. Ortmann, et al. A Randomized Trial of Exemestane after Two to Three Years of Tamoxifen Therapy in Postmenopausal Women with Primary Breast Cancer N. Engl. J. Med., March 11, 2004; 350(11): 1081 - 1092. [Abstract] [Full Text] [PDF]

				M. Colleoni, N. Rotmensz, G. Martinelli, R. Gelber, A. Coates, and A. Goldhirsch Lesson learned from high-dose chemotherapy for high-risk breast cancer (What you see is what you mean) Ann. Onc., February 1, 2004; 15(2): 355 - 356. [Full Text] [PDF]

				International Breast Cancer Study Group Adjuvant Chemotherapy Followed by Goserelin Versus Either Modality Alone for Premenopausal Lymph Node-Negative Breast Cancer: A Randomized Trial J Natl Cancer Inst, December 17, 2003; 95(24): 1833 - 1846. [Abstract] [Full Text] [PDF]