[Adjuvant treatment of breast cancer in 2004. A review of the 8th consensus conference of St. Gallen and new study results].
The emerging evidence gained from randomized controlled trials accelerated the widespread use of adjuvant endocrine and cytotoxic regimens and their combinations for most breast cancer patients. Even for the earliest cancer stages with low-risk tumour profiles, endocrine treatment can be recommended as adjuvant therapy if the tumour is endocrine responsive. The 8th consensus conference on early breast cancer in St. Gallen in 2003 opened a plethora of treatment options to nearly all breast cancer patients. Key issues were the introduction of adjuvant therapy with anastrozole for those postmenopausal patients with contra-indications or intolerability of tamoxifen and the definition of a group of 'more potent' regimens like the FEC- and the taxane-based regimens for high-risk patients. Unfortunately the expert panel did not clearly define any recommendations either for choosing optimal candidates for purely endocrine treatments (which are a valid option for all patients with optimal endocrine responsive disease or arguments against chemotherapy) or for the proper high-risk patients scheduled for more aggressive regimens. In the meantime, new or updated studies have provided additional information helpful for the shared decision-making with our patients. The Canadian MA.17 study revealed a significant benefit from adding a sequential therapy with letrozole after 5 years of tamoxifen compared to tamoxifen alone. Together with the updated evaluation from the ATAC trial and the Italian ITA study, the role of adjuvant treatment with aromatase inhibitors is steadily strengthened. Several studies comparing taxane-based and taxane-free regimens showed significant survival and/or recurrence benefits for the former. These data should be communicated to the patients. In the complex process of decision-making, a profound knowledge of the study results and the early and complete involvement of the woman and her personal beliefs are mandatory.
Kahlert
S
S
Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe-Grosshadern, Ludwig-Maximilians-Universität München, München, Deutschland. steffen.kahlert@med.uni-muenchen.de
von Koch
F
F
Ditsch
N
N
Untch
M
M
D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D019091:Critical Pathways; D005260:Female; D006801:Humans; D009367:Neoplasm Staging; D016896:Treatment Outcome
D018931:Antineoplastic Agents, Hormonal