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Aktuelle Strategien zur Systemtherapie des frühen Mammakarzinoms von der 18. Internationalen St.-Gallen-Konsensuskonferenz

Current strategies regarding systemic therapy for early breast cancer from the 18th International St. Gallen Consensus Conference

  • Onkologiekongresse
  • Published:
Die Onkologie Aims and scope

Zusammenfassung

Hintergrund

Seit über 30 Jahren findet regelmäßig die Internationale St.-Gallen(SG)-Konsensuskonferenz zur Behandlung des primären Mammakarzinoms (SGBCC) statt. Bei diesem Konsensus handelt es sich um ein internationales Meinungsbild von Expertinnen und Experten unterschiedlicher Länder und Fachdisziplinen.

Rationale

Hier sollen die Abstimmungsergebnisse der SGBCC-Panel-Mitglieder für den Klinikalltag in Deutschland diskutiert werden.

Grundlage

Basis der Diskussion sind die im März 2023 aktualisierten Therapieempfehlungen der Arbeitsgemeinschaft Gynäkologische Onkologie (AGO Organkommission Mamma; Version 2023.1D).

Ergebnis

Die diesjährige 18. SGBCC fokussierte auf praxisorientierte Fragestellungen. Die individuelle Krankheitssituation und Nutzen-Risiko-Abwägung wurden bevorzugt anhand von Fallbeispielen diskutiert und mit der aktuellen Datenlage abgeglichen. Im Vordergrund der wichtigsten Abstimmungsergebnisse zur Systemtherapie standen die endokrine Therapie und CDK4/6-Inhibition, die Immuntherapie sowie die BRCA-Bestimmung und PARP-Inhibition.

Abstract

Background

For more than 30 years, The St. Gallen (SG) International Consensus Conference on the treatment of patients with primary breast cancer (SGBCC) has been taking place regularly. As the St. Gallen consensus panel consists of experts from different countries and disciplines, the votes represent an international cross-section of opinions

Rationale

From the German perspective it is considered useful to discuss the results of the votes with respect to the clinical routine in Germany

Basis

The discussion is related to the German guidelines of the ‚Arbeitsgemeinschaft Gynäkologische Onkologie‘ (AGO Organkommission Mamma, Version 2023.1D) which is updated every year, most recently in March 2023.

Results

This year’s 18th SGBCC focused on practice-oriented issues. The individual disease situation and benefit-risk assessment were mainly based on patient cases and put in the context of current data. Here, we discuss the most important voting results on systemic therapy with a focus on endocrine therapy plus CDK4/6 inhibition, immunotherapy and PARP inhibition together with germline BRCA testing.

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Literatur

  1. AGO Kommission Mamma Diagnostik und Therapie früher und fortgeschrittener Mammakarzinome (März 2023). https://www.ago-online.de/fileadmin/ago-online/downloads/_leitlinien/kommission_mamma/2023/AGO_2023D_Gesamtdatei.pdf. Zugegriffen: 3. Apr. 2023

  2. Davies C, Pan H, Godwin J et al (2013) Long-term effects of continuing adjuvant tamoxifen to 10 years versus stop** at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial. Lancet 381(9869):805–816

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Díaz-Roldán J, Eguía-Larrea M, Rubio-Sánchez T et al (2022) Systematic review of synchronous contralateral axillary metastases in breast cancer: really M1 disease? Breast Cancer 29(1):9–18

    Article  PubMed  Google Scholar 

  4. Domchek SM, Postel-Vinay S, Im S‑A et al (2020) Olaparib and durvalumab in patients with germline BRCA-mutated metastatic breast cancer (MEDIOLA): an open-label, multicentre, phase 1/2, basket study. Lancet Oncol 21(9):1155–1164

    Article  CAS  PubMed  Google Scholar 

  5. Francis PA, Regan MM, Fleming GF et al (2015) Adjuvant ovarian suppression in premenopausal breast cancer. N Engl J Med 372(5):436–446

    Article  PubMed  Google Scholar 

  6. Gluz O, Nitz U, Christgen M (2022) Impact of age, recurrence score and ovarian function suppression on endocrine response to short preoperative endocrine therapy: analysis of ADAPT and ADAPTcycle trials. Ann Oncol 33(suppl_7):S808–S869

    Google Scholar 

  7. Gnant M, Fitzal F, Rinnerthaler G et al (2021) Duration of adjuvant aromatase-inhibitor therapy in postmenopausal breast cancer. N Engl J Med 385(5):395–405

    Article  CAS  PubMed  Google Scholar 

  8. Goss PE, Ingle JN, Pritchard KI et al (2016) Extending aromatase-inhibitor adjuvant therapy to 10 years. N Engl J Med 375(3):209–219

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Gray RG, Rea D, Handley K et al (2013) aTTom: long-term effects of continuing adjuvant tamoxifen to 10 years versus stop** at 5 years in 6,953 women with early breast cancer. JCO 31(18_suppl):5

    Article  Google Scholar 

  10. Harbeck N, Rastogi P, Martin M et al (2021) Adjuvant abemaciclib combined with endocrine therapy for high-risk early breast cancer: updated efficacy and Ki-67 analysis from the monarchE study. Ann Oncol 32(12):1571–1581

    Article  CAS  PubMed  Google Scholar 

  11. Johnston SRD, Harbeck N, Hegg R et al (2020) Abemaciclib combined with endocrine therapy for the adjuvant treatment of HR+, HER2−, node-positive, high-risk, early breast cancer (monarchE). J Clin Oncol 38(34):3987–3998

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Kalinsky K, Barlow WE, Gralow JR et al (2021) 21-gene assay to inform chemotherapy benefit in node-positive breast cancer. N Engl J Med 385(25):2336–2347

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Konstantinopoulos PA, Waggoner S, Vidal GA et al (2019) Single-arm phases 1 and 2 trial of niraparib in combination with pembrolizumab in patients with recurrent platinum-resistant ovarian carcinoma. JAMA Oncol 5(8):1141–1149

    Article  PubMed  PubMed Central  Google Scholar 

  14. Loibl S, Jackisch C, Rastogi P et al (2019) GeparDouze/NSABP B‑59: a randomized double-blind phase III clinical trial of neoadjuvant chemotherapy with atezolizumab or placebo in patients with Triple Negative Breast Cancer (TNBC) followed by adjuvant atezolizumab or placebo. Ann Oncol 30:iii38

    Article  Google Scholar 

  15. Loibl S, Huang C‑S, Mano MS et al (2022) Adjuvant trastuzumab emtansine in HER2-positive breast cancer patients with HER2-negative residual invasive disease in KATHERINE. NPJ Breast Cancer 8(1):106

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Loibl S, Schneeweiss A, Huober J et al (2022) Neoadjuvant durvalumab improves survival in early Triple-Negative Breast Cancer independent of pathological complete response. Ann Oncol 33(11):1149–1158

    Article  CAS  PubMed  Google Scholar 

  17. Loibl S, Jassem J, Sonnenblick A et al (2022) VP6-2022: adjuvant pertuzumab and trastuzumab in patients with early HER‑2 positive breast cancer in APHINITY: 8.4 years’ follow-up. Ann Oncol 33(9):986–987

    Article  Google Scholar 

  18. Nelson DR, Brown J, Morikawa A et al (2022) Breast cancer-specific mortality in early breast cancer as defined by high-risk clinical and pathologic characteristics. PLoS ONE 17(2):e264637

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Nitz UA, Gluz O, Kümmel S et al (2022) Endocrine therapy response and 21-gene expression assay for therapy guidance in HR+/HER2− early breast cancer. J Clin Oncol 40(23):2557–2567

    Article  CAS  PubMed  Google Scholar 

  20. O’Shaughnessy J, Rastogi P, Harbeck N (2021) Adjuvant abemaciclib combined with endo-crine therapy: updated results from monarchE. ESMO Virutal Plenary Session, October 14, 2021

    Google Scholar 

  21. Pan H, Gray R, Braybrooke J et al (2017) 20-year risks of breast-cancer recurrence after stop** endocrine therapy at 5 years. N Engl J Med 377(19):1836–1846

    Article  PubMed  PubMed Central  Google Scholar 

  22. Park-Simon T, Müller V, Jackisch C et al (2023) AGO recommendations for the diagnosis and treatment of patients with Early Breast Cancer (EBC): update 2023. Breast Care 18(4):288–304. https://doi.org/10.1159/000531578

    Article  Google Scholar 

  23. Partridge AH, Niman SM, Ruggeri M et al (2023) Interrupting endocrine therapy to attempt pregnancy after breast cancer. N Engl J Med 388(18):1645–1656

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Piccart M, van ’t Veer LJ, Poncet C et al (2021) 70-gene signature as an aid for treatment decisions in early breast cancer: updated results of the phase 3 randomised MINDACT trial with an exploratory analysis by age. Lancet Oncol 22(4):476–488

    Article  CAS  PubMed  Google Scholar 

  25. Reinisch M, Seiler S, Hauzenberger T et al (2021) Efficacy of endocrine therapy for the treatment of breast cancer in men: results from the MALE phase 2 randomized clinical trial. JAMA Oncol 7(4):565–572

    Article  PubMed  PubMed Central  Google Scholar 

  26. Rugo HS, Llombart-Cussac A, Andre F et al (2020) KEYLYNK-009: A phase II/III, open-label, randomized study of pembrolizumab (pembro) plus olaparib vs pembro plus chemotherapy after induction with first-line pembro plus chemotherapy in patients with locally recurrent inoperable or metastatic Triple-Negative Breast Cancer (TNBC). J Clin Oncol 38(15_suppl):TPS596–TPS596

    Article  Google Scholar 

  27. Schmid P, Cortes J, Pusztai L et al (2020) Pembrolizumab for early Triple-Negative Breast Cancer. N Engl J Med 382(9):810–821

    Article  CAS  PubMed  Google Scholar 

  28. Schmid P, Cortes J, Dent R et al (2022) Event-free survival with pembrolizumab in early Triple-Negative Breast Cancer. N Engl J Med 386(6):556–567

    Article  CAS  PubMed  Google Scholar 

  29. Smith I, Robertson J, Kilburn L et al (2020) Long-term outcome and prognostic value of Ki67 after perioperative endocrine therapy in postmenopausal women with hormone-sensitive early breast cancer (POETIC): an open-label, multicentre, parallel-group, randomised, phase 3 trial. Lancet Oncol 21(11):1443–1454

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Sparano J, Gray RJ, Makower D (2022) Trial Assigning Individualized Options for Treatment (TAILORx): An Update Including 12-Year Event Rates. Abstract no. GS1-05 2022 San Antonio Breast Cancer Symposium

    Google Scholar 

  31. Sparano JA, Gray RJ, Ravdin PM et al (2019) Clinical and genomic risk to guide the use of adjuvant therapy for breast cancer. N Engl J Med 380(25):2395–2405

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Tarantino P, Tayob N, Dang CT (2022) Adjuvant trastuzumab emtansine versus paclitaxel plus trastuzumab for stage I HER2+ breast cancer: 5‑year results and correlative analyses from ATEMPT (TBCRC033). Abstract no. PD18-01 2022 San Antonio Breast Cancer Symposium

    Google Scholar 

  33. Tolaney SM, Tarantino P, Graham N et al (2023) Adjuvant paclitaxel and trastuzumab for node-negative, HER2-positive breast cancer: final 10-year analysis of the open-label, single-arm, phase 2 APT trial. Lancet Oncol 24(3):273–285

    Article  CAS  PubMed  Google Scholar 

  34. Tung NM, Robson ME, Ventz S et al (2020) TBCRC 048: phase II study of olaparib for metastatic breast cancer and mutations in homologous recombination-related genes. J Clin Oncol 38(36):4274–4282

    Article  CAS  PubMed  Google Scholar 

  35. Tutt A, Garber JE, Kaufman B et al (2021) OlympiA: A phase III, multicenter, randomized, placebo-controlled trial of adjuvant olaparib after (neo)adjuvant chemotherapy in patients with germline BRCA1/2 mutations and high-risk HER2-negative early breast cancer. J Clin Oncol 39(18_suppl):LBA1–LBA1

    Article  Google Scholar 

  36. Tutt ANJ, Garber JE, Kaufman B et al (2021) Adjuvant olaparib for patients with BRCA1− or BRCA2-mutated breast cancer. N Engl J Med 384(25):2394–2405

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Yadav S, Hu C, Hart SN et al (2020) Evaluation of germline genetic testing criteria in a hospital-based series of women with breast cancer. J Clin Oncol 38(13):1409–1418

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Yadav S (2022) Population-based estimates of contralateral breast cancer risk among carriers of Germline pathogenic variants in ATM, BRCA1, BRCA2, CHEK2 and PALB2. Abstract no. GS4-04 2022 San Antonio Breast Cancer Symposium

    Google Scholar 

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Danksagung

Die Autorinnen und Autoren danken Birgit-Kristin Pohlmann, Nordkirchen, für die redaktionelle Begleitung bei der Manuskripterstellung.

Author information

Authors and Affiliations

  1. Immanuel Klinik Märkische Schweiz, Buckow & Immanuel Klinik Rüdersdorf, Medizinische Hochschule Brandenburg Theodor Fontane, Rüdersdorf bei Berlin, Deutschland

    Diana Lüftner

  2. Klinik für Frauenheilkunde und Geburtshilfe, Brustzentrum, Campus Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Deutschland

    Maggie Banys-Paluchowski

  3. Klinik für Frauenheilkunde und Geburtshilfe, Brustzentrum, Universitätsklinikum Augsburg, Augsburg, Deutschland

    Nina Ditsch

  4. Frauenklinik des , Deutschland, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland

    Peter A. Fasching

  5. Klinik für Gynäkologie und Geburtshilfe, Sana-Klinikum Offenbach GmbH, Offenbach, Deutschland

    Christian Jackisch

  6. Universitätsfrauenklinik Ulm, Ulm, Deutschland

    Wolfgang Janni

  7. Klinik für Strahlentherapie (Radioonkologie), Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland

    David Krug

  8. Klinik für Gynäkologie und Geburtshilfe, interdisziplinäres Brustzentrum, HELIOS Klinikum Berlin Buch, Berlin, Deutschland

    Michael Untch

  9. Brustzentrum, Frauenklinik, LMU Klinikum München, München, Deutschland

    Nadia Harbeck

  10. Brustzentrum Kantonsspital St. Gallen, St. Gallen, Schweiz

    Jens Huober

Authors
  1. Diana Lüftner
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  2. Maggie Banys-Paluchowski
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  3. Nina Ditsch
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  4. Peter A. Fasching
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  5. Christian Jackisch
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  6. Wolfgang Janni
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  7. David Krug
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  8. Michael Untch
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  9. Nadia Harbeck
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  10. Jens Huober
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Corresponding author

Correspondence to Diana Lüftner.

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Interessenkonflikt

D. Lüftner erhielt Honorare von Amgen, AstraZeneca, Celgene, Daiichi Sankyo, Eli Lilly, Gilead, GSK, high5md, Loreal, Novartis, onkowissen, Pfizer, Roche und Teva. M. Banys-Paluchowski erhielt Honorar von Roche, Novartis, Pfizer, pfm, Eli Lilly, onkowissen, Seagen, AstraZeneca, Eisai, Amgen, Samsung, Canon, MSD, GSK, Daiichi Sankyo, Gilead, Sirius Pintuition, Pierre Fabre, Exact Sciences, Syantra, Stemline und Studienunterstützung von EndoMag, Mammotome, Merit Medical, Gilead, Hologic, Exact Sciences, Sirius Medical. N. Ditsch erhielt Honorar von AstraZeneca, Daiichi Sankyo, Gilead Sciences, Lilly, Merit Medical, Molecular Health, MSD, Novartis, onkowissen, Pfizer, pfm medical, Roche, Seagen, Teva. P.A. Fasching erhielt Zuschüsse von BioNTech, Pfizer, Cepheid sowie Honorar von Novartis, Pfizer, Daiichi Sankyo, AstraZeneca, Esai, Merck Sharp & Dohme, Lilly, Pierre Fabre, Seagen, Roche, Agendia, Sanofi-Aventis, Gilead, Mylan und Menarini. C. Jackisch erhielt Honorar von AstraZeneca, Lilly, Celgene, MSD, Eisai, Novartis, Pfizer, Gilead, Daiichi Sankyo, Medupdate, Streamed Up, Roche und Forschungsunterstützung von Exact Sciences. W. Janni erhielt Honorar von AstraZeneca, Celgene, Chugai, Daiichi Sankyo, Eisai, Exact Science, GSK, Janssen, Lilly, Menarini, MSD, Novartis, Sanofi-Aventis, Roche, Pfizer, Seagen, Gilead, Inivata. D. Krug erhielt Honorar von Merck Sharp & Dohme, med update, onkowissen, best practice onkologie, ESO, ESMO, Gilead und Pfizer sowie Forschungsunterstützung von Merck KGaA. M. Untch: Alle Honorare an den AG/Institution (Referenten- und Beratertätigkeit): Amgen, AstraZeneca, Daiichi Sankyo, Eisai, Lilly, MSD Merck, Myriad Genetics, Pfizer, Roche, Pierre Fabre, Novartis, Molecular Health, Agendia, GSK, Seagen, Gilead, Medac, Stemline, Genzyme. N. Harbeck erhielt Honorare für Vorträge bzw. Beratung von Amgen, AstraZeneca, Daiichi Sankyo, Gilead, Lilly, MSD, Novartis, Pierre Fabre, Pfizer, Roche, Sandoz, Sanofi, Seagen, Viatris, Zuellig Pharma. J. Huober erhielt Forschungsunterstützung von Celgene, Novartis, Hexal, Lilly. Honorar für Vortragstätigkeiten von Lilly, Novartis, Roche, Pfizer, AstraZeneca, MSD, Celgene, Eisai, AbbVie, Seagen, Gilead, Daiichi. Honorar für Beratertätigkeit von Lilly, Novartis, Roche, Pfizer, Hexal, AstraZeneca, MSD, Celgene, AbbVie, Daiichi, Gilead. Reisekostenunterstützung von Roche, Pfizer, Novartis, Celgene, Daiichi, Gilead.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Nadi Harbeck und Jens Huober: St.-Gallen-Panel-Mitglied

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Lüftner, D., Banys-Paluchowski, M., Ditsch, N. et al. Aktuelle Strategien zur Systemtherapie des frühen Mammakarzinoms von der 18. Internationalen St.-Gallen-Konsensuskonferenz. Onkologie 29, 1097–1108 (2023). https://doi.org/10.1007/s00761-023-01414-w

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