The 18th St.Gallen International Breast Cancer Conference (SGBCC 2023) was held in Vienna, known as the “Capital of World Music”, from March 15th to 18th, 2023 local time. On the last day of the conference, the highlight was the expert voting session. Oncology Frontier has compiled expert voting on the treatment of HER2 positive breast cancer, BRCA Associated treatment, Bone Modifying Therapy , oligo-metastatic disease, and molecular diagnosis topics. Additionally, a selection of these topics was presented for readers to vote on, allowing them to immerse themselves in the St.Gallen atmosphere of early breast cancer treatment decision-making.
HER2 Positive
(1) For a patient with stage 1, HER2 positive breast cancer, the preferred adjuvant treatment is:
1. TCHP (Docetaxel, Carboplatin, Trastuzumab, Pertuzumab)
2. TH (Paclitaxel, Trastuzumab)
3. T-DM1 (Ado-trastuzumab emtansine)
4. Abstain
SGBCC Expert Voting:
(2)For patients who present with clinically node-negative breast cancer, and who receive neoadjuvant TCHP, and achieve a pCR, the appropriate adjuvant regimen is:
1. Trastuzumab
2. Trastuzumab and Pertuzumab
3. Abstain
SGBCC Expert Voting:
(3) A patient with HER2 positive breast cancer receives neoadjuvant TCHP. At surgery there is residual disease that is HER2 negative by FISH and by IHC. Her adjuvant therapy should be:
1. trastuzumab emtansine (T-DM1)
2. Anthracycline-based chemotherapy
3. Both of the above
4. Abstain
SGBCC Expert Voting:
BRCA Associated
(4) A 43 year old patient has been diagnosed with stage 2, node-positive TNBC. She is also found to have a BRCA1 mutation. She receives neoadjuvant KN522. At surgery, she has residual disease. ln the adjuvant setting, in addition to pembrolizumab, she should receive:
1. Capecitabine
2. Olaparib
3. Both of the above, sequentially
4. Abstain
SGBCC Expert Voting:
(5) A 43 year old patient has been diagnosed with stage 3, node-positive ER positive HER2 negative breast cancer. She is also found to have a BRCA2 mutation. She receives neo/adjuvant dose-dense AC/T. In the adjuvant setting, in addition to optimal endocrine therapy, she should receive:
1. Olaparib
2. Abemaciclib
3. Both of the above, sequentially
4. Abstain
SGBCC Expert Voting:
(6) In addition to other standard treatments, all patients with BRCA1 or BRCA2 mutations who receive neo/adjuvant chemotherapy should receive platinum-based treatment.This viewpoint is:
1. Correct
2. Incorrect
3. Abstain
SGBCC Expert Voting:
Bone Modifying Therapy
(7) Adjuvant bone modifying therapy should be recommended to which group of women with postmenopausal breast cancer?
1. All
2. All ER-positive tumors except ER-negative tumors
3. Only patients with stage 2 or 3 (ER-positive or negative)
4. Only patients with stage 2 or 3 and ER-positive
5. Only patients with stage 3 (ER-positive or negative)
6. Abstain
SGBCC Expert Voting:
Oligometastatic Disease
(8) A patient has been diagnosed with ER negative HER2 positive breast cancer, and stagings cans disclose a 4 cm tumor in the breast, positive axillary LN, and an isolated pulmonary nodule. The patient receives induction therapy with THP and has a complete clinical response.Do you think the patient should also receive:
1. Surgery only
2. Radiation therapy only
3. Both surgery and radiation therapy
4. None of the above
5. Abstain
SGBCC Expert Voting:
Audience Voting :
(9) A patient with ER-negative, HER2-negative breast cancer, staging scans show a 4 cm tumor in the breast, axillary lymph nodes are positive, and an isolated lung nodule is present. The patient undergoes taxane/platinum induction therapy and achieves complete clinical remission. Do you think the patient should also receive:
1. Surgery only
2. Radiation therapy only
3. Both surgery and radiation therapy
4. None of the above
5. Abstain
SGBCC Expert Voting:
(10) A patient has been diagnosed with ER positive HER2 positive breast cancer, and staging scans disclose a 4 cm tumor in the breast, positive axillary LN, and an isolated pulmonary nodule.The patient receives induction therapy with CDK4/6i and Al treatment, and has a complete clinical response. Do you think the patient should also receive:
1. Surgery only
2. Radiation therapy only
3. Both surgery and radiation therapy
4. None of the above
5. Abstain
SGBCC Expert Voting:
(11) A patient has stage 2 breast cancer on one side and is found to have an isolated contralateral axillary LN. This patient should receive definite therapy with curative intent including contralateral axillary surgery and radiation therapy, and adjuvant treatment as standard. Do you think:
1. Yes
2. No
3. Abstain
SGBCC Expert Voting:
(12) A patient has stage 2 breast cancer on one side and is found to have an isolated sternal metastasis. This patient should receive definite therapy with curative intent including surgery and radiation therapy including the sternum, and adjuvant treatment as standard.Do you think:
1. Yes
2. No
3. Abstain
SGBCC Expert Voting:
Molecular Diagnosis
(13) Patients with early stage breast cancer should have ctDNA testing after surgery to determine their risk for future recurrence.Do you think:
1. Yes
2. No
3. Abstain
SGBCC Expert Voting:
(13)Routine use of ctDNA in early breast cancer should happen when there is:
1. Adequate assembly of data proving prognostic significance
2. Only after prospective studies have shown that testing hastherapeutic implications
3. Abstain
SGBCC Expert Voting:
(15) A patient has received neoadjuvant therapy as part of a clinical trial. At the end of the tria she undergoes breast surgery, and as part of the trial, has a sample sent to test for presence of ctDNA. Should the test results be disclosed to the patient?
1. Yes
2. No
3. Abstain
SGBCC Expert Voting:
(16) A patient has received neoadjuvant chemotherapy/trastuzumab/pertuzumab as part of a clinical trial. At the end of the trial she undergoes breast surgery, with a pCR. As part of the trial, a test sent for presence of ctDNA shows positive residual tumor DNA. Should she receive trastuzumab emtansine?
1. Yes
2. No
3. Abstain
SGBCC Expert Voting:
(17) Five years ago, a postmenopausal woman received standard therapy for a stage 3, ER positive, HER2 negative breast cancer. She is eligible for a clinical trial in which ctDNA testing is performed to determine ongoing treatment. In the trial, patients whose ctDNA discloses an ESR1 mutation are randomized to ongoing aromatase inhibitor therapy or a switch to fulvestrant. ln light of data from the metastatic setting, are you at equipoise that this is a fair study?
1. Yes
2. No
3. Abstain
SGBCC Expert Voting:
SGBCC Expert Voting, which one do you pick?
Due to formatting constraints, we have selected several questions for readers to vote on. The question stems have been abbreviated (please refer to the previous text for the specific question content). We welcome all readers to answer the questions related to early TNBC treatment decisions and to experience the atmosphere of St. Gallen’s early breast cancer treatment.
1. For stage 1 HER2+ breast cancer patients, the preferred adjuvant therapy is (select one):
• TCHP (Docetaxel, Carboplatin, Trastuzumab, Pertuzumab)
• TH (Paclitaxel, Trastuzumab)
• T-DM1 (Ado-trastuzumab emtansine)
• Abstain
2. If TCHP neoadjuvant treatment achieves pCR, the suitable adjuvant option is (select one):
• Trastuzumab (Herceptin)
• Trastuzumab and Pertuzumab (Herceptin and Perjeta)
• Abstain
3. If TCHP neoadjuvant treatment does not achieve pCR, and the residual disease is HER2-negative, the adjuvant treatment option should be (select one):
• Ado-trastuzumab emtansine (T-DM1)
• Anthracycline-based chemotherapy
• Both of the above, sequentially
• Abstain
4. For a patient with non-pCR after KN522 regimen neoadjuvant treatment, apart from Pertuzumab, the additional adjuvant treatment should be (select one):
• Capecitabine
• Olaparib
• Both of the above, sequentially
• Abstain
5. For an ER+, BRCA-2 mutation-positive patient after neoadjuvant treatment, the choice for adjuvant therapy combined with endocrine therapy is (select one):
• Olaparib
• Abemaciclib
• Both of the above, sequentially
• Abstain
6. Should (neo)adjuvant therapy for BRCA-1/2 mutation patients always include platinum-based chemotherapy? (select one):
• Correct
• Incorrect
• Abstain
7. Should early-stage breast cancer patients undergo ctDNA testing after surgery? (select one):
• Yes
• No
• Abstain
“SGBCC Voting Venue (Photo: Maple Leaf)”
