title: Thresholds for therapies: highlights of the St Gallen International Expert Consensus on the primary therapy of early breast cancer 2009.
abstract: The 11(th) St Gallen (Switzerland) expert consensus meeting on the primary treatment of early breast cancer in March 2009 maintained an emphasis on targeting adjuvant systemic therapies according to subgroups defined by predictive markers. Any positive level of estrogen receptor (ER) expression is considered sufficient to justify the use of endocrine adjuvant therapy in almost all patients. Overexpression or amplification of HER2 by standard criteria is an indication for anti-HER2 therapy for all but the very lowest risk invasive tumours. The corollary is that ER and HER2 must be reliably and accurately measured. Indications for cytotoxic adjuvant therapy were refined, acknowledging the role of risk factors with the caveat that risk per se is not a target. Proliferation markers, including those identified in multigene array analyses, were recognised as important in this regard. The threshold for indication of each systemic treatment modality thus depends on different criteria which have been separately listed to clarify the therapeutic decision-making algorithm.
authors.affiliation: International Breast Cancer Study Group, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland. aron.goldhirsch@ibcsg.org
authors.forename: A
authors.initials: A
authors.lastname: Goldhirsch
authors.forename: J N
authors.initials: JN
authors.lastname: Ingle
authors.forename: R D
authors.initials: RD
authors.lastname: Gelber
authors.forename: A S
authors.initials: AS
authors.lastname: Coates
authors.forename: B
authors.initials: B
authors.lastname: Thürlimann
authors.forename: H-J
authors.initials: HJ
authors.lastname: Senn
mesh_terms: D000465:Algorithms; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000378:metabolism / Q000628:therapy*; D018567:Breast Neoplasms, Male / Q000378:metabolism / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D009376:Neoplasms, Hormone-Dependent / Q000378:metabolism / Q000628:therapy*; D018714:Radiotherapy, Adjuvant; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000037:antagonists & inhibitors / Q000096:biosynthesis; D011960:Receptors, Estrogen / Q000096:biosynthesis
chemical_list: D018931:Antineoplastic Agents, Hormonal; D018719:Erb-b2 Receptor Tyrosine Kinases; D011960:Receptors, Estrogen