Interpretation on hot topics of the 16th St. Gallen International Breast Cancer Conference

doi:10.3877/cma.j.issn.1674-0807.2019.05.001

Abstract

Abstract:

In the 16th St. Gallen International Breast Cancer of 2019 Conference, the dignosis and treatment of patients with primary breast cancer was discussed by a working group of leading breast cancer experts. In this manuscript, based on the recommendations of consensus and guidelines, we discussed the research progress and hot issues in three major fields of breast cancer diagnosis and treatment: surgery, systemic therapy and neoadjuvant therapy. For surgery, we focused on the sentinel lymph node biopsy, local treatment of elderly patients, prophylactic mastectomy in patients with BRCA mutation and surgical treatment range after neoadjuvant chemotherapy. With regard to systemic treatment, we focused on de-escalating and escalating treatments for luminal, HER-2-positive and triple-negative breast cancer.The neoadjuvant therapy focuses on its indications, regimens of chemotherapy, and escalating treatment for residual lesions after chemotherapy.

Key words: Breast neoplasms, Surgical procedures, operative, Chemotherapy, adjuvant

Sheng Chen, Liang Huang, Min He, Siyu Wu, Zhimin Shao. Interpretation on hot topics of the 16th St. Gallen International Breast Cancer Conference[J]. Chinese Journal of Breast Disease(Electronic Edition), 2019, 13(05): 257-262.

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References 39

[1]	Giuliano AE, Ballman KV, McCall L, et al. Effect of axillary dissection vs no axillary dissection on 10-year overall survival among women with invasive breast cancer and sentinel node metastasis: the ACOSOG Z0011 (alliance) randomized clinical trial[J]. JAMA, 2017, 318(10): 918-926.
[2]	Galimberti V, Cole BF, Viale G, et al. Axillary dissection versus no axillary dissection in patients with breast cancer and sentinel-node micrometastases (IBCSG 23-01): 10-year follow-up of a randomised, controlled phase 3 trial[J]. Lancet Oncol, 2018, 19(10): 1385-1393.
[3]	Gentilini O, Veronesi U. Abandoning sentinel lymph node biopsy in early breast cancer? A new trial in progress at the European Institute of Oncology of Milan (SOUND: sentinel node vs observation after axillary UltraSouND) [J]. Breast, 2012, 21(5): 678-681.
[4]	de Boniface J, Frisell J, Andersson Y, et al. Survival and axillary recurrence following sentinel node-positive breast cancer without completion axillary lymph node dissection: the randomized controlled SENOMAC trial[J]. BMC Cancer, 2017, 17(1): 379.
[5]	El Hage Chehade H, Headon H, El Tokhy O, et al. Is sentinel lymph node biopsy a viable alternative to complete axillary dissection following neoadjuvant chemotherapy in women with node-positive breast cancer at diagnosis? An updated meta-analysis involving 3，398 patients[J]. Am J Surg, 2016, 212(5): 969-981.
[6]	de Glas NA, Kiderlen M, Bastiaannet E, et al. Postoperative complications and survival of elderly breast cancer patients: a FOCUS study analysis[J]. Breast Cancer Res Treat，2013，138(2): 561-569.
[7]	Pepping RMC, Portielje JEA, van de Water W, et al. Primary endocrine therapy in older women with breast cancer[J]. Curr Geriatr Rep, 2017, 6(4): 239-246.
[8]	Early Breast Cancer Trialists’ Collaborative Group, Darby S, McGale P, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10，801 women in 17 randomised trials[J]. Lancet, 2011, 378(9804): 1707-1716.
[9]	Early Breast Cancer Trialists’ Collaborative Group, McGale P, Taylor C, et al. Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials[J]. Lancet，2014，383(9935): 2127-2135.
[10]	Wickberg Å, Liljegren G, Killander F, et al. Omitting radiotherapy in women ≥ 65 years with low-risk early breast cancer after breast-conserving surgery and adjuvant endocrine therapy is safe[J]. Eur J Surg Oncol, 2018, 44(7): 951-956.
[11]	Wong SM, Freedman RA, Sagara Y, et al. Growing use of contralateral prophylactic mastectomy despite no improvement in long-term survival for invasive breast cancer[J]. Ann Surg, 2017, 265(3): 581-589.
[12]	Jagsi R, Hawley ST, Griffith KA, et al. Contralateral prophylactic mastectomy decisions in a population-cased sample of patients with early-stage breast cancer[J]. JAMA Surg, 2017, 152(3): 274-282.
[13]	Chowdhury M, Euhus D, Onega T, et al. A model for individualized risk prediction of contralateral breast cancer[J]. Breast Cancer Res Treat，2017，161(1): 153-160.
[14]	van Maaren MC, de Munck L, de Bock GH, et al. 10 year survival after breast-conserving surgery plus radiotherapy compared with mastectomy in early breast cancer in the Netherlands: a population-based study[J]. Lancet Oncol, 2016，17(8): 1158-1170.
[15]	Mieog JS, van der Hage JA, van de Velde CJ. Neoadjuvant chemotherapy for operable breast cancer[J]. Br J Surg，2007，94(10): 1189-1200.
[16]	Chen AM, Meric-Bernstam F, Hunt KK, et al. Breast conservation after neoadjuvant chemotherapy: the MD Anderson cancer center experience[J]. J Clin Oncol, 2004, 22(12): 2303-2312.
[17]	Mittendorf EA, Buchholz TA, Tucker SL, et al. Impact of chemotherapy sequencing on local-regional failure risk in breast cancer patients undergoing breast-conserving therapy[J]. Ann Surg, 2013, 257(2): 173-179.
[18]	Choi J, Laws A, Hu J, et al. Margins in breast-conserving surgery after neoadjuvant therapy[J]. Ann Surg Oncol, 2018, 25(12): 3541-3547.
[19]	Feliciano Y, Mamtani A, Morrow M, et al. Do calcifications seen on mammography after neoadjuvant chemotherapy for breast cancer always need to be excised? [J]. Ann Surg Oncol, 2017, 24(6): 1492-1498.
[20]	Early Breast Cancer Trialists’ Collaborative Group. Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomised trials[J]. Lancet Oncol, 2018, 19(1): 27-39.
[21]	Tadros AB, Yang WT, Krishnamurthy S, et al. Identification of patients with documented pathologic complete response in the breast after neoadjuvant chemotherapy for omission of axillary surgery[J]. JAMA Surg, 2017，152(7): 665-670.
[22]	Heil J, Kummel S, Schaefgen B, et al. Diagnosis of pathological complete response to neoadjuvant chemotherapy in breast cancer by minimal invasive biopsy techniques[J]. Br J Cancer, 2015，113(11): 1565-1570.
[23]	Omarini C, Guaitoli G, Noventa S, et al. Impact of time to surgery after neoadjuvant chemotherapy in operable breast cancer patients[J]. Eur J Surg Oncol，2017，43(4): 613-618.
[24]	Sparano JA, Gray RJ, Makower DF, et al. Adjuvant chemotherapy guided by a 21-gene expression assay in breast cancer[J]. N Engl J Med, 2018, 379(2): 111-121.
[25]	Gluz O, Nitz UA, Christgen M, et al. West German study group phase Ⅲ PlanB trial: first prospective outcome data for the 21-gene recurrence score assay and concordance of prognostic markers by central and local pathology assessment[J]. J Clin Oncol, 2016, 34(20): 2341-2349.
[26]	Blum JL, Flynn PJ, Yothers G, et al. Anthracyclines in early breast cancer: the ABC Trials-USOR 06-090, NSABP B-46-I/USOR 07132, and NSABP B-49 (NRG oncology) [J]. J Clin Oncol, 2017, 35(23): 2647-2655.
[27]	Caparica R, Bruzzone M, Poggio F, et al. Anthracycline and taxane-based chemotherapy versus docetaxel and cyclophosphamide in the adjuvant treatment of HER2-negative breast cancer patients: a systematic review and meta-analysis of randomized controlled trials[J]. Breast Cancer Res Treat, 2019, 174(1): 27-37.
[28]	Francis PA, Pagani O, Fleming GF, et al. Tailoring adjuvant endocrine therapy for premenopausal breast cancer[J]. N Engl J Med, 2018, 379(2): 122-137.
[29]	Gray R, Early Breast Cancer Trialists’ Collaborative Group. Effects of prolonging adjuvant aromatase inhibitor therapy beyond five years on recurrence and cause-specific mortality: an EBCTCG meta-analysis of individual patient data from 12 randomised trials including 24，912 women[EB/OL]. [2018-12-06]. URL
[30]	von Minckwitz G, Procter M, de Azambuja E, et al. Adjuvant pertuzumab and trastuzumab in early HER2-positive breast cancer[J]. N Engl J Med, 2017, 377(2): 122-131.
[31]	Martin M, Holmes FA, Ejlertsen B, et al. Neratinib after trastuzumab-based adjuvant therapy in HER2-positive breast cancer (ExteNET): 5-year analysis of a randomised, double-blind, placebo-controlled, phase 3 trial[J]. Lancet Oncol, 2017，18(12): 1688-1700.
[32]	Tolaney SM, Barry WT, Dang CT, et al. Adjuvant paclitaxel and trastuzumab for node-negative, HER2-positive breast cancer[J]. N Engl J Med, 2015, 372(2): 134-141.
[33]	Earl HM, Hiller L, Vallier AL, et al. 6 versus 12 months of adjuvant trastuzumab for HER2-positive early breast cancer (PERSEPHONE): 4-year disease-free survival results of a randomised phase 3 non-inferiority trial[J]. Lancet, 2019, 393(10191): 2599-2612.
[34]	von Minckwitz G, Schneeweiss A, Loibl S, et al. Neoadjuvant carboplatin in patients with triple-negative and HER2-positive early breast cancer (GeparSixto; GBG 66): a randomised phase 2 trial[J]. Lancet Oncol, 2014, 15(7): 747-756.
[35]	Sikov WM, Berry DA, Perou CM, et al. Impact of the addition of carboplatin and/or bevacizumab to neoadjuvant once-per-week paclitaxel followed by dose-dense doxorubicin and cyclophosphamide on pathologic complete response rates in stage Ⅱ to Ⅲ triple-negative breast cancer: CALGB 40603 (Alliance) [J]. J Clin Oncol, 2015, 33(1): 13-21.
[36]	Early Breast Cancer Trialists’ Collaborative Group. Increasing the dose intensity of chemotherapy by more frequent administration or sequential scheduling: a patient-level meta-analysis of 37 298 women with early breast cancer in 26 randomised trials[J]. Lancet, 2019, 393(10179): 1440-1452.
[37]	Gianni L, Pienkowski T, Im YH, et al. Efficacy and safety of neoadjuvant pertuzumab and trastuzumab in women with locally advanced, inflammatory, or early HER2-positive breast cancer (NeoSphere): a randomised multicentre, open-label, phase 2 trial[J]. Lancet Oncol, 2012, 13(1): 25-32.
[38]	Masuda N, Lee SJ, Ohtani S, et al. Adjuvant capecitabine for breast cancer after preoperative chemotherapy[J]. N Engl J Med, 2017, 376(22): 2147-2159.
[39]	von Minckwitz G, Huang CS, Mano MS, et al. Trastuzumab emtansine for residual invasive HER2-positive breast cancer [J]. N Engl J Med, 2019, 380(7): 617-628.

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