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

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Journal of Clinical Oncology, Vol 21, Issue 17 (September), 2003: 3357-3365
© 2003 American Society for Clinical Oncology


SPECIAL ARTICLE

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 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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Association of DNA Methylation of Phosphoserine Aminotransferase with Response to Endocrine Therapy in Patients with Recurrent Breast Cancer
Cancer Res., May 15, 2005; 65(10): 4101 - 4117.
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JCOHome page
F. Andre, A. Khalil, K. Slimane, C. Massard, M. C. Mathieu, S. Vignot, H. Assi, S. Delaloge, and M. Spielmann
Mitotic Index and Benefit of Adjuvant Anthracycline-Based Chemotherapy in Patients With Early Breast Cancer
J. Clin. Oncol., May 1, 2005; 23(13): 2996 - 3000.
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Ann OncolHome page
M. Colleoni, S. Li, R. D. Gelber, A. S. Coates, M. Castiglione-Gertsch, K. N. Price, J. Lindtner, C.-M. Rudenstam, D. Crivellari, J. Collins, et al.
Timing of CMF chemotherapy in combination with tamoxifen in postmenopausal women with breast cancer: role of endocrine responsiveness of the tumor
Ann. Onc., May 1, 2005; 16(5): 716 - 725.
[Abstract] [Full Text] [PDF]


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JCOHome page
G. von Minckwitz, G. Raab, A. Caputo, M. Schutte, J. Hilfrich, J. U. Blohmer, B. Gerber, S. D. Costa, E. Merkle, H. Eidtmann, et al.
Doxorubicin With Cyclophosphamide Followed by Docetaxel Every 21 Days Compared With Doxorubicin and Docetaxel Every 14 Days As Preoperative Treatment in Operable Breast Cancer: The GEPARDUO Study of the German Breast Group
J. Clin. Oncol., April 20, 2005; 23(12): 2676 - 2685.
[Abstract] [Full Text] [PDF]


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JCOHome page
J. Bonneterre, H. Roche, P. Kerbrat, A. Bremond, P. Fumoleau, M. Namer, M.-J. Goudier, S. Schraub, P. Fargeot, and I. Chapelle-Marcillac
Epirubicin Increases Long-Term Survival in Adjuvant Chemotherapy of Patients With Poor-Prognosis, Node-Positive, Early Breast Cancer: 10-Year Follow-Up Results of the French Adjuvant Study Group 05 Randomized Trial
J. Clin. Oncol., April 20, 2005; 23(12): 2686 - 2693.
[Abstract] [Full Text] [PDF]


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Mol. Cell. ProteomicsHome page
S. O. Wurtz, I. J. Christensen, A.-S. Schrohl, H. Mouridsen, U. Lademann, V. Jensen, and N. Brunner
Measurement of the Uncomplexed Fraction of Tissue Inhibitor of Metalloproteinases-1 in the Prognostic Evaluation of Primary Breast Cancer Patients
Mol. Cell. Proteomics, April 1, 2005; 4(4): 483 - 491.
[Abstract] [Full Text] [PDF]


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Clin. Cancer Res.Home page
W.-Y. Lee, H. H.W. Chen, N.-H. Chow, W.-C. Su, P.-W. Lin, and H.-R. Guo
Prognostic Significance of Co-expression of RON and MET Receptors in Node-Negative Breast Cancer Patients
Clin. Cancer Res., March 15, 2005; 11(6): 2222 - 2228.
[Abstract] [Full Text] [PDF]


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JCOHome page
E. P. Mamounas
Continuing Evolution in Breast Cancer Surgical Management
J. Clin. Oncol., March 10, 2005; 23(8): 1603 - 1606.
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JCOHome page
S. Braun and B. Naume
Circulating and Disseminated Tumor Cells
J. Clin. Oncol., March 10, 2005; 23(8): 1623 - 1626.
[Full Text] [PDF]


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JCOHome page
S. Dellapasqua, M. Colleoni, R. D. Gelber, and A. Goldhirsch
Adjuvant Endocrine Therapy for Premenopausal Women With Early Breast Cancer
J. Clin. Oncol., March 10, 2005; 23(8): 1736 - 1750.
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Proc. Natl. Acad. Sci. USAHome page
H. Y. Chang, D. S. A. Nuyten, J. B. Sneddon, T. Hastie, R. Tibshirani, T. Sorlie, H. Dai, Y. D. He, L. J. van't Veer, H. Bartelink, et al.
From The Cover: Robustness, scalability, and integration of a wound-response gene expression signature in predicting breast cancer survival
PNAS, March 8, 2005; 102(10): 3738 - 3743.
[Abstract] [Full Text] [PDF]


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JAMAHome page
W. J. Gradishar and V. G. Kaklamani
Adjuvant Therapy of Breast Cancer in the Elderly: Does One Size Fit All?
JAMA, March 2, 2005; 293(9): 1118 - 1120.
[Full Text] [PDF]


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Endocr Relat CancerHome page
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]


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JCOHome page
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]


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JCOHome page
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]


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Ann OncolHome page
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]


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JCOHome page
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]


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Clin. Cancer Res.Home page
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]


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NEJMHome page
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.
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Ann OncolHome page
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]


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JCOHome page
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]


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Ann OncolHome page
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]


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


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Clin. Cancer Res.Home page
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]


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JAMAHome page
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]


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The OncologistHome page
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]


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NEJMHome page
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]


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Ann OncolHome page
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]


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JNCI J Natl Cancer InstHome page
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]



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