14th St. Gallen International Breast Cancer Conference 2015: Evidence, Controversies, Consensus - Primary Therapy of Early Breast Cancer: Opinions Expressed by German Experts

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Abstract

The key topics of this year's 14th St. Gallen Consensus Conference on the diagnosis and therapy of primary breast cancer were again questions about breast surgery and axillary surgery, radio-oncology and systemic therapy options in consideration of tumor biology, and the clinical application of multigene assays. This year, the consensus conference took place in Vienna. From a German perspective, it makes sense to substantiate the results of the vote of the international panel representing 19 countries in light of the updated national therapy recommendations of the AGO (Arbeitsgemeinschaft Gynäkologische Onkologie). Therefore, 14 German breast cancer experts, 3 of whom are members of the International St. Gallen Panel, have commented on the voting results of the St. Gallen Consensus Conference 2015 in relation to clinical routine in Germany.

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Tailoring therapies—improving the management of early breast cancer: St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2015

A S Coates, E Winer, A Goldhirsch … (2015)

The 14th St Gallen International Breast Cancer Conference (2015) reviewed new evidence on locoregional and systemic therapies for early breast cancer. This manuscript presents news and progress since the 2013 meeting, provides expert opinion on almost 200 questions posed to Consensus Panel members, and summarizes treatment-oriented classification of subgroups and treatment recommendations.

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Tumor-infiltrating lymphocytes and response to neoadjuvant chemotherapy with or without carboplatin in human epidermal growth factor receptor 2-positive and triple-negative primary breast cancers.

Carsten Denkert, Gunter von Minckwitz, Jan C Brase … (2015)

Modulation of immunologic interactions in cancer tissue is a promising therapeutic strategy. To investigate the immunogenicity of human epidermal growth factor receptor 2 (HER2) -positive and triple-negative (TN) breast cancers (BCs), we evaluated tumor-infiltrating lymphocytes (TILs) and immunologically relevant genes in the neoadjuvant GeparSixto trial.

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Neoadjuvant carboplatin in patients with triple-negative and HER2-positive early breast cancer (GeparSixto; GBG 66): a randomised phase 2 trial.

Gunter von Minckwitz, Andreas Schneeweiss, Sibylle Loibl … (2014)

Preclinical data suggest that triple-negative breast cancers are sensitive to interstrand crosslinking agents, and that synergy may exist for the combination of a taxane, trastuzumab, and a platinum salt for HER2-positive breast cancer. We therefore aimed to assess the efficacy of the addition of carboplatin to neoadjuvant therapy for triple-negative and HER2-positive breast cancer. Patients with previously untreated, non-metastatic, stage II-III, triple-negative breast cancer and HER2-positive breast cancer were enrolled. Patients were treated for 18 weeks with paclitaxel (80 mg/m(2) once a week) and non-pegylated liposomal doxorubicin (20 mg/m(2) once a week). Patients with triple-negative breast cancer received simultaneous bevacizumab (15 mg/kg intravenously every 3 weeks). Patients with HER2-positive disease received simultaneous trastuzumab (8 mg/kg initial dose with subsequent doses of 6 mg/kg intravenously every 3 weeks) and lapatinib (750 mg daily). Patients were randomly assigned in a 1:1 ratio with dynamic allocation and minimisation, stratified by biological subtype and Ki-67 level to receive, at the same time as the backbone regimens, either carboplatin (AUC 1·5 [2·0 for the first 329 patients] once a week) or no carboplatin. The primary endpoint the proportion of patients who achieved a pathological complete response (defined as ypT0 ypN0), analysed for all patients who started treatment; a p value of less than 0·2 was deemed significant for the primary endpoint. This trial is registered with ClinicalTrials.gov, number NCT01426880. 296 patients were randomly assigned to receive carboplatin and 299 to no additional carboplatin, of whom 295 and 293 started treatment, respectively. In this final analysis, 129 patients (43·7%, 95% CI 38·1-49·4) in the carboplatin group achieved a pathological complete response, compared with 108 patients (36·9%, 31·3-42·4) without carboplatin (odds ratio 1·33, 95% CI 0·96-1·85; p=0·107). Of the patients with triple-negative breast cancer, 84 (53·2%, 54·4-60·9) of 158 patients achieved a pathological complete response with carboplatin, compared with 58 (36·9%, 29·4-44·5) of 157 without (p=0·005). Of the patients with HER2-positive tumours, 45 (32·8%, 25·0-40·7) of 137 patients achieved a pathological complete response with carboplatin compared with 50 (36·8%, 28·7-44·9) of 136 without (p=0·581; test for interaction p=0·015). Haematological and non-haematological toxic effects that were significantly more common in the carboplatin group than in the no-carboplatin group included grade 3 or 4 neutropenia (192 [65%] vs 79 [27%]), grade 3 or 4 anaemia (45 [15%] vs one [<1%]), grade 3 or 4 thrombocytopenia (42 [14%] vs one [<1%]), and grade 3 or 4 diarrhoea (51 [17%] vs 32 [11%]); carboplatin was more often associated with dose discontinuations (141 [48%] with carboplatin and 114 [39%] without carboplatin; p=0·031). The frequency of grade 3 or 4 haematological events decreased from 82% (n=135) to 70% (n=92) and grade 3 or 4 non-haematological events from 78% (n=128) to 59% (n=77) in the carboplatin arm when the dose of carboplatin was reduced from AUC 2·0 to 1·5. The addition of neoadjuvant carboplatin to a regimen of a taxane, an anthracycline, and targeted therapy significantly increases the proportion of patients achieving a pathological complete response. This regimen seems to increase responses in patients with triple-negative breast cancer, but not in those with HER2-positive breast cancer. GlaxoSmithKline, Roche, and Teva. Copyright © 2014 Elsevier Ltd. All rights reserved.

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Journal

Journal ID (publisher-id): BRC

Journal ID (pmc): BRC

Journal ID (doi): 10.1159/issn.1661-3791

Title: Breast Care

Publisher: S. Karger AG

ISSN (Print): 1661-3791

ISSN (Electronic): 1661-3805

Publication date Subscription-year: 2015

Publication date (Print): July 2015

Publication date (Electronic): 23 June 2015

Volume: 10

Issue: 3

Pages: 211-219

Affiliations

^aKlinik für Gynäkologie und Geburtshilfe, Sana-Klinikum Offenbach, Germany; ^bBrustzentrum, Frauenklinik der Universität München (LMU), München, Germany; ^cBrustzentrum, Universitätsfrauenklinik Ulm, Germany; ^dGerman Breast Group, Neu-Isenburg, Universitäts-Klinikum Frankfurt and Senologische Onkologie, Düsseldorf, Germany; ^eUniversitätsfrauenklinik Rostock, Germany; ^fInstitut für Pathologie, Medizinische Hochschule Hannover, Germany; ^gKlinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Germany; ^hGemeinschaftspraxis für Interdisziplinäre Onkologie und Hämatologie, Freiburg i.Br., Germany; ⁱKlinik für Gynäkologie und Geburtshilfe, Klinikum Frankfurt-Höchst, Frankfurt/M., Germany; ^jKlinik und Poliklinik für Strahlentherapie und Radioonkologie, LMU München, Germany; ^kNationales Centrum für Tumorerkrankungen (NCT) und Universitätsfrauen-klinik Heidelberg, Germany; ^lUniversitätsklinik und Poliklinik für Gynäkologie, Halle (Saale), Germany; ^mGerman Breast Group, Neu-Isenburg; Klinik für Gynäkologie und Geburtshilfe, Sana-Klinikum Offenbach, Germany; ⁿFrauenklinik des Universitätsklinikums Erlangen, Comprehensive Cancer Center Erlangen, Germany; ^oKlinik für Gynäkologie und Brustzentrum, Charité Berlin-Mitte, Berlin, Germany; ^pUniversitätsfrauenklinik Magdeburg, Germany; ^qGemeinschaftspraxis Onkologie, Ravensburg, Germany; ^rGemeinschaftspraxis Gynäkologie und Geburtshilfe, Mannheim, Germany; ^sFrauenklinik des Universitätsklinikums Erlangen, Comprehensive Cancer Center Erlangen-Nürnberg, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany; ^tUniversitätsfrauenklinik Düsseldorf, Germany; ^uUniversitätsfrauenklinik Ulm, Germany; ^vGynäkologisch-Onkologische Praxis, Hannover, Germany; ^wKlinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Germany; ^xFrauenklinik, Klinikum St. Marien, Amberg, Germany; ^yKlinik für Gynäkologie und Geburtshilfe, Interdisziplinäres Brustzentrum, HELIOS Klinikum Berlin Buch, Germany

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Publisher ID: 433590 Pmcid ID: PMC4569213 Other ID: Breast Care 2015;10:211-219

DOI: 10.1159/000433590

PMC ID: PMC4569213

PubMed ID: 26557827

SO-VID: c45265dd-9a20-473e-9c61-e8b229423bce

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14th St. Gallen International Breast Cancer Conference 2015: Evidence, Controversies, Consensus - Primary Therapy of Early Breast Cancer: Opinions Expressed by German Experts

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Most cited references 14

Tailoring therapies—improving the management of early breast cancer: St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2015

Tumor-infiltrating lymphocytes and response to neoadjuvant chemotherapy with or without carboplatin in human epidermal growth factor receptor 2-positive and triple-negative primary breast cancers.

Neoadjuvant carboplatin in patients with triple-negative and HER2-positive early breast cancer (GeparSixto; GBG 66): a randomised phase 2 trial.

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