Strategies for subtypes—dealing with the diversity of breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011

TLDR

Systemic therapy recommendations are guided by breast cancer subtype classification, with broad treatment guidelines that also account for disease extent, host factors, patient preferences, and socioeconomic constraints. Subtypes can be approximated with clinicopathological criteria, and progress has been made in defining better tolerated local therapies—e.g., accelerated radiation and selective omission of axillary dissection—without compromising efficacy. The 2011 St Gallen Consensus adopted a subtype‑based classification, recommending endocrine therapy for Luminal A (and part of Luminal B), while chemotherapy—plus trastuzumab for HER2‑positive cases—is advised for most Luminal B, HER2‑positive, and triple‑negative patients.

Abstract

The 12th St Gallen International Breast Cancer Conference (2011) Expert Panel adopted a new approach to the classification of patients for therapeutic purposes based on the recognition of intrinsic biological subtypes within the breast cancer spectrum. For practical purposes, these subtypes may be approximated using clinicopathological rather than gene expression array criteria. In general, systemic therapy recommendations follow the subtype classification. Thus, 'Luminal A' disease generally requires only endocrine therapy, which also forms part of the treatment of the 'Luminal B' subtype. Chemotherapy is considered indicated for most patients with 'Luminal B', 'Human Epidermal growth factor Receptor 2 (HER2) positive', and 'Triple negative (ductal)' disease, with the addition of trastuzumab in 'HER2 positive' disease. Progress was also noted in defining better tolerated local therapies in selected cases without loss of efficacy, such as accelerated radiation therapy and the omission of axillary dissection under defined circumstances. Broad treatment recommendations are presented, recognizing that detailed treatment decisions need to consider disease extent, host factors, patient preferences, and social and economic constraints.