St. Gallen consensus 2009: A radically different approach to treating early bre...( A radically different approach to ch...),Health

A radically different approach to choosing the best treatment options for early breast cancer has been proposed by an international panel of experts in a report from the 11th St Gallen conference.

The report is published online in the cancer journal, Annals of Oncology [1] today (Thursday 18 June), and represents the consensus on early breast cancer treatment that emerged from the conference of more than 4,800 participants from 101 countries, which took place in March 2009.

The authors expect the consensus report to change clinical practice. While it continues to recognise that early breast cancer is a heterogeneous disease and that patients should receive personalised care targeted at their particular type of disease, the report proposes a different way of assessing the disease, its risk and the appropriate treatment.

The authors write: "In distilling patient and tumour features to reach patient treatment decisions, the panel has adopted a fundamentally different approach from that used in previous consensus reports. Clinical decisions in systemic adjuvant therapy of early breast cancer must address three distinct questions: (i) what justifies the use of endocrine therapy, (ii) what justifies the use of anti-HER2 therapy, and (iii) what justifies the use of chemotherapy. Because these decisions are based on quite separate criteria, the previous attempt to produce a single-risk categorization and a separate therapy recommendation are no longer considered appropriate." The authors then give a new algorithm for clinicians to use when deciding on the best treatment approach for each patient.

One of the authors, Professor Richard Gelber (Professor in Biostatistics at Harvard University and Dana-Farber Cancer Institute, Boston, MA, USA and Director of the Statistical Center, International Breast Cancer Study Group), said: "This consensus is important because it provides solutions to open questions in controversial areas con
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