The 18th St. Gallen International Breast Cancer Conference (SGBCC 2023) was held in Vienna, the “City of Music,” from March 15 to 18, 2023. SGBCC brought together breast cancer opinion leaders from around the world to discuss and vote on the most cutting-edge and controversial topics in the diagnosis and treatment of early-stage breast cancer. This resulted in the updated St. Gallen International Expert Consensus on Early Breast Cancer every two years. Oncology Frontier has compiled expert votes on the topic of treatment decisions for triple-negative breast cancer (TNBC) to provide insight into the atmosphere of decision-making at St. Gallen regarding early-stage breast cancer treatment.
Early Treatment Decisions for Triple-Negative Breast Cancer
(1) Carboplatin should be included in the chemotherapy regimen for patients receiving neoadjuvant therapy for stage 2 or 3 TNBC who are also receiving taxane, anthracycline, and cyclophosphamide based chemotherapy when pembrolizumab is being administered.
1. Yes
2. No
3. Abstain
SGBCC Expert Vote:
(2) Carboplatin should be included in the chemotherapy regimen for patients receiving
neoadjuvant therapy for stage 2 or 3 TNBC who are also receiving taxane, anthracycline, and cyclophosphamide based chemotherapy when pembrolizumab is not being administered.
1. Yes
2. No
3. Abstain
SGBCC Expert Vote:
(3) Multiple studies have suggested that dose-dense adjuvant chemotherapy improves outcomes. For that reason, the ‘AC/EC’ phase of the KN522 regimen with concurrent pembrolizumab should be given every 2 weeks, and not every 3 weeks as was done in the clinical trial.
1. Yes
2. No
3. Uncertain, pending confirmation of safety and efficacy before abandoning the 3-week option
4. Abstain
SGBCC Expert Vote:
(4)A healthy premenopausal woman has received taxane/carboplatin followed by AC chemotherapy, with concurrent pembrolizumab, as neoadjuvant treatment for TNBC. If she has a pCR should she also receive adjuvant pembrolizumab?
1. Yes
2. No
3. Abstain
SGBCC Expert Vote:
(5)A healthy 60 year old woman has a clinical T2N0 triple negative breast cancer, of about 2-3 cm in size. She is a candidate for BCS without needing neoadjuvant therapy. Your preferred approach would be:
1. Neoadjuvant chemotherapy combined with pembrolizumab
2. Neoadjuvant chemotherapy
3. Surgery
4. Abstain
SGBCC Expert Vote:
(6) Should we use neoadjuvant pembrolizumab-based chemotherapy for stage 1 TNBC patients?
1. Yes
2. No, neoadjuvant chemotherapy alone is suitable for smaller TNBC tumors
3. No, I recommend surgery first for stage 1 TNBC patients without clinical indications for neoadjuvant treatment, followed by chemotherapy if recommended
4. Abstain
SGBCC Expert Vote:
(7)A 45 year old woman has undergone primary surgery for TNBC, disclosing a stage 2 cancer with positive nodal involvement. In addition to standard chemotherapy, should she receive adjuvant pembrolizumab?
1. Yes
2. No
3. Abstain
SGBCC Expert Vote:
SGBCC Expert Voting: Which option would you choose?
Due to formatting constraints, we have abbreviated the question prompts. You can refer to the previous text for the full question content. We invite readers to participate in answering the relevant questions regarding early-stage TNBC treatment decisions and experience the atmosphere of decision-making at St. Gallen.
1. For stage 2/3 TNBC neoadjuvant treatment, should carboplatin be added to the TAC regimen combined with pembrolizumab? (Single Choice)
• Yes
• No
• Abstain
2. For stage 2/3 TNBC neoadjuvant treatment without pembrolizumab in the TAC regimen, should carboplatin be added? (Single Choice)
• Yes
• No
• Abstain
3. Can the AC/EC standard regimen of KN522 (q3w) be changed to a dose-dense regimen (q2w)? (Single Choice)
• Yes
• No
• Uncertain, pending confirmation of safety and efficacy before abandoning the 3-week option
• Abstain
4. Should patients achieving pCR with the KN522 neoadjuvant regimen receive adjuvant pembrolizumab treatment? (Single Choice)
• Yes
• No
• Abstain
5. T2N0, 2-3 cm tumor, planning breast-conserving surgery, is it recommended to undergo neoadjuvant treatment or proceed directly to surgery? (Single Choice)
• Neoadjuvant chemotherapy combined with pembrolizumab
• Neoadjuvant chemotherapy
• Surgery
• Abstain
6. Should we use pembrolizumab-based neoadjuvant chemotherapy for stage 1 TNBC patients? (Single Choice)
• Yes
• No, neoadjuvant chemotherapy alone is suitable for smaller TNBC tumors
• No, I recommend surgery first for stage 1 TNBC patients without clinical indications for neoadjuvant treatment, followed by chemotherapy if recommended
• Abstain
7. A 45-year-old, lymph node-positive, stage 2 TNBC patient after surgery, is adjuvant chemotherapy recommended to be combined with pembrolizumab? (Single Choice)
• Yes
• No
• Abstain
SGBCC Voting Scene (Photograph: Maple)
