Primary Therapy of Early Breast Cancer: Evidence, Controversies, Consensus

Michael Untch; Christoph Thomssen; Ingo Bauerfeind; Michael Braun; Sara Y. Brucker; Ricardo Felberbaum; Friederike Hagemann; Renate Haidinger; Arnd Hönig; Jens Huober; Christian Jackisch; Hans-Christian Kolberg; Cornelia Kolberg-Liedtke; Thorsten Kühn; Diana Lüftner; Nicolai Maass; Toralf Reimer; Andreas Schneeweiss; Eva Schumacher-Wulf; Florian Schütz; Marc Thill; Rachel Wuerstlein; Peter A. Fasching; Nadia Harbeck

doi:10.1055/a-0897-6457

Geburtshilfe und Frauenheilkunde, Table of Contents

CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2019; 79(06): 591-604
DOI: 10.1055/a-0897-6457

GebFra Science

Review/Übersicht

Georg Thieme Verlag KG Stuttgart · New York

Primary Therapy of Early Breast Cancer: Evidence, Controversies, Consensus

Spectrum of Opinion of German Specialists on the 16th St. Gallen International Breast Cancer Conference (Vienna 2019) Article in several languages: English | deutsch

Authors

Michael Untch^*

¹Klinik für Gynäkologie und Geburtshilfe, interdisziplinäres Brustzentrum, HELIOS Klinikum Berlin Buch, Berlin, Germany
Christoph Thomssen^*

²Klinik und Poliklinik für Gynäkologie, Martin-Luther-Universität, Halle-Wittenberg, Halle/Saale, Germany
Ingo Bauerfeind^**

³Interdisziplinäres Brustkrebszentrum, Frauenklinik, Klinikum Landshut, Landshut, Germany
Michael Braun^**

⁴Interdisziplinäres Brustzentrum, Frauenklinik, Rotkreuzklinikum München, München, Germany
Sara Y. Brucker^*^#

⁵Universitäts-Frauenklinik Tübingen, Tübingen, Germany
Ricardo Felberbaum^**

⁶Interdisziplinäres Brustzentrum Kempten – Allgäu (IBZK-A), Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Kempten, Klinikverbund Kempten-Oberallgäu, Kempten, Germany
Friederike Hagemann^**

⁷Brustzentrum, Frauenklinik der Universität München (LMU), München, Germany
Renate Haidinger^**

⁸Brustkrebs Deutschland e. V.
Arnd Hönig^**

⁹Brustzentrum, Frauenklinik, Katholisches Klinikum Mainz, Mainz, Germany
Jens Huober^*^#

¹⁰Universitätsfrauenklinik Ulm, Brustzentrum, Ulm, Germany
Christian Jackisch^*

¹¹Klinik für Gynäkologie und Geburtshilfe, Sana-Klinikum Offenbach, Offenbach, Germany
Hans-Christian Kolberg^**

¹²Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Marienhospital Bottrop gGmbH, Bottrop, Germany
Cornelia Kolberg-Liedtke^*

¹³Charité – Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
Thorsten Kühn^*

¹⁴Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Esslingen, Esslingen, Germany
Diana Lüftner^*

¹⁵Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Charité Campus Benjamin Franklin, Berlin, Germany
Nicolai Maass^**

¹⁶Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
Toralf Reimer^**

¹⁷Brustzentrum, Universitätsfrauenklinik und Poliklinik, Klinikum Südstadt Rostock, Rostock, Germany
Andreas Schneeweiss^*

¹⁸Sektionsleiter Gynäkologische Onkologie des Universitätsklinikum (UKHD), Fellow des Deutschen Krebsforschungszentrum (DKFZ), Nationales Centrum für Tumorerkrankungen (NCT), Universitätsklinikum Heidelberg, Heidelberg, Germany
Eva Schumacher-Wulf^**

¹⁹Mamma Mia! Das Brustkrebsmagazin, Kronberg, Germany
Florian Schütz^**

²⁰Brustzentrum, Sektion Senologie, UniversitätsKlinikum Heidelberg, Heidelberg, Germany
Marc Thill^*

²¹Klinik für Gynäkologie und Gynäkologische Onkologie, Agaplesion Markus Krankenhaus, Frankfurt/Main, Germany
Rachel Wuerstlein^**

⁷Brustzentrum, Frauenklinik der Universität München (LMU), München, Germany
Peter A. Fasching^*

²²Frauenklinik des Universitätsklinikums Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
Nadia Harbeck^*^#

⁷Brustzentrum, Frauenklinik der Universität München (LMU), München, Germany

Abstract

The results of the international St. Gallen Consensus Conference for the treatment of patients with primary breast cancer were discussed this year by a working group of leading breast cancer experts in view of the therapy recommendations for everyday clinical practice in Germany. Three of the breast cancer experts are also members of this yearʼs St. Gallen panel. The comparison of the St. Gallen recommendations with the annually updated treatment recommendations of the AGO 2019 as well as the S3 guideline is useful, since the recommendations of the St. Gallen panel represent the opinions of experts from various countries and disciplines. The recommendations of the S3 guideline and AGO are based on evidence-based research of the literature. This yearʼs 16th St. Gallen conference featured the motto “Magnitude of clinical benefit”. In addition to the evidence-based data, each therapeutic decision must also undergo a benefit/risk assessment of the patientʼs individual situation and be discussed with the patient.

Key words

St. Gallen consensus 2019 - early breast cancer - locoregional therapy - axilla - neoadjuvant treatment - systemic therapy

Full Text

References

References/Literatur
1 Kolberg H-C, Schneeweiss A, Fehm TN. et al. Update Breast Cancer 2019 Part 3 – Current Developments in Early Breast Cancer: Review and Critical Assessment by an International Expert Panel. Geburtsh Frauenheilk 2019; 79: 470-482
2 Ditsch N, Untch M, Thill M. et al. AGO Recommendations for the Diagnosis and Treatment of Patients with Early Breast Cancer: Update 2019. Breast Care 2019; 14 im Druck. Online: http://www.ago-online.de last access: 25.05.2019
3 Reimer T, Stachs A, Nekljudova V. et al. Restricted Axillary Staging in Clinically and Sonographically Node-Negative Early Invasive Breast Cancer (c/iT1-1) in the Context of Breast Conserving Therapy: First Results Following Commencement of the Intergroup-Sentinel-Mamma (INSEMA) Trial. Geburtsh Frauenheilk 2017; 77: 149-157
4 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). Breast 2012; 21: 678-681
5 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. JAMA 2017; 318: 918-926
6 Donker M, van Tienhoven G, Straver ME. et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981-22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol 2014; 15: 1303-1310
7 Online: http://www.astro.org last access: 27.03.2019
8 Smith BD, Arthur DW, Buchholz TA. et al. Consensus Statement der ASTRO. Int J Rad Oncol Bio Phys 2009; 74: 987-1001
9 Online: http://www.estro.org last access: 27.03.2019
10 Polgàr C, Van Limbergen E, Pötter R. et al. Patient selection for accelerated partial-breast irradiation (APBI) after breast-conserving surgery: recommendations of the Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) breast cancer working group based on clinical evidence (2009). Radiother Oncol 2010; 94: 264-273
11 Schmid P, Adams S, Rugo HS. et al. Atezolizumab and Nab-Paclitaxel in Advanced Triple-Negative Breast Cancer. N Engl J Med 2018;
12 Emens LA, Loi S, Rugo HS. et al. Impassion130: Efficacy in immune biomarker subgroups from the global, randomized, double-blind, placebo-controlled, Phase III study of Atezolizumab + nab-paclitaxel in patients with treatment-naïve, locally advanced or metastatic triple-negative breast cancer. SABCS 2018; abstract/oral presentation GS1-04.
13 Pagani O, Regan MM. Francis PA; TEXT and SOFT Investigators, International Breast Cancer Study Group. Exemestane with ovarian suppression in premenopausal breast cancer. N Engl J Med 2014; 371: 1358-1359
14 Sparano JA, Gray RJ, Makower DF. et al. Prospective Validation of 21-Gene Expression Assay in Breast Cancer. N Engl J Med 2015; 373: 2005-2014
15 Cardoso F, vanʼt Veer LJ, Bogaerts J. et al. 70-Gene Signature as an Aid to Treatment Decisions in Early-Stage Breast Cancer. N Engl J Med 2016; 375: 717-729
16 Gluz O, Nitz UA, Christgen M. et al. West German Study Group Phase III Plan B Trial: First Prospective Outcome Data for the 21-Gene Recurrence Score Assay and Concordance of Prognostic markers by Central and Local Pathology Assessment. J Clin Oncol 2016; 24: 2341-2349
17 Loibl S, OʼShaughnessy J, Untch M. et al. Addition of the PARP inhibitor veliparib plus carboplatin or carboplatin alone to standard neoadjuvant chemotherapy in triple-negative breast cancer (BrighTNess). A randomised, phase 3 trial. Lancet Oncol 2018; 19: 497-509
18 Sparano JA, Zhao F, Martino S. et al. Long-Term Follow-Up of the E1199 Phase III Trial Evaluating the Role of Taxane and Schedule in Operable Breast Cancer. J Clin Oncol 2015; 33: 2353-2360
19 Hahnen E, Lederer B, Hauke J. et al. Germline Mutation Status, Pathological Complete Response, and Disease-free Survival in Triple-Negative Breast Cancer: Secondary Analysis of the GeparSixto Randomized Clinical Trial. JAMA Oncol 2017; 3: 1378-1385
20 Petrelli F. The value of platinum agents as neoadjuvant chemotherapy in triple-negative breast cancers: a systematic review and meta-analysis. Breast Cancer Res Treat 2014; 144: 223
21 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. Lancet Oncol 2017;
22 Masuda N, Lee S-J, Ohtani S. et al. Adjuvant Capecitabine for Breast Cancer after Preoperative Chemotherapy. N Engl J Med 2017; 376: 2147-2156
23 Zujewski JA, Rubinstein L. CREATE-X a role for capecitabine in early-stage breast cancer: an analysis of available data. NPJ Breast Cancer 2017; 3: 27
24 von Minckwitz G, Huang CS, Mano MS. et al. Trastuzumab Emtansine for Residual Invasive HER2-Positive Breast Cancer. N Engl J Med 2018;
25 Early Breast Cancer Trialistsʼ Collaborative Group (EBCTCG). Adjuvant bisphosphonate treatment in early breast cancer: meta-analyses of individual patient data from randomised trials. Lancet 2015; 386: 1353
26 Gnant M, Mlineritsch B, Stoeger H. et al. Adjuvant endocrine therapy plus zoledronic acid in premenopausal women with early-stage breast cancer: 62-month follow-up from the ABCSG-12 randomised trial. Lancet Oncol 2011; 12: 631-641
27 Coleman RE, Finkelstein D, Barrios CH. et al. Adjuvant denosumab in early breast cancer: First results from international multicenter randomized phase III placebo controlled D-CARE study. J Clin Oncol 2018; 36 (Suppl.) 501
28 Gnant M, Pfeiler G, Steger GG. et al. Adjuvant denosumab in early breast cancer: Disease-free survival analysis of 3,425 postmenopausal patients in the ABCSG-18 trial. J Clin Oncol 2018; 36 (no. 15_suppl): 500 doi:10.1200/JCO.2018.36.15_suppl.500
29 Gnant M, Pfeiler G, Dubsky PC. et al. Adjuvant denosumab in breast cancer (ABCSG-18): a multicentre, randomised, double-blind, placebo-controlled trial. Lancet 2015; 386: 433-443