The 18th St. Gallen International Breast Cancer Conference (SGBCC 2023) took place in Vienna, the “City of Music,” from March 15th to 18th, 2023. SGBCC gathered breast cancer opinion leaders from around the world to discuss and vote on the latest and most controversial topics in early breast cancer diagnosis and treatment, culminating in the biennial St. Gallen International Expert Consensus on Early Breast Cancer. On the final day of the conference, the expert voting session took center stage. Oncology Frontier has compiled the following summary of the expert votes on surgical treatment.
Axillary Surgery
(1) A patient has undergone neoadjuvant treatment with AC/T chemotherapy, with a significant clinical response. At surgery, there is residual disease in the axilla. The tumor is triple negative. For each of these scenarios, would you recommend completion axillary dissection or axillary radiation?
Nodal burden: Macrometastasis in 1 of 3 SLN
1. Treatment choice: AxLND
2. Treatment choice: AxRT
3. Both
4. Neither
5. Abstain
SGBCC Expert Vote:
Audience Vote:
Breast Surgery
(2) In a postmenopausal patient with ER+/Her2- clinically node-negative breast cancer and two ipsilateral breast cancers in two neighboring quadrants that would be amenable two double tumorectomy with two separate incisions…
1. No breast reconstruction after breast removal
2. Breast reconstruction after breast removal
3. Removal of both tumors
4. Abstain
SGBCC Expert Vote:
Breast-Conserving Surgery/Adjuvant Radiation After Local-Regional Recurrence
(3) A 63 year old woman was treated 9 years ago for a stage 2, node-negative, breast cancer with lumpectomy and radiation therapy, as well as adjuvant systemic treatment. Now she has had ipsilateral tumor recurrence. No> grade 1 or only very localized grade 2 side effects at the level of the skin and/or the soft tissues are present. The tumor is ER positive and HER2 negative.Staging scans including axilla are negative. The lesion is <2 cm in size, 3 cm from nipple, and would be amenable to breast conserving surgery with acceptable aesthetic results. You would recommend:
1. Breast removal
2. Breast-conserving surgery
3. Breast-conserving surgery with radiation
4. Abstain
SGBCC Expert Vote:
Hormone Therapy After Local-Regional Recurrence During Aromatase Inhibitor (AI) Adjuvant Therapy
(4) A patient has developed isolated local regional recurrence while on adjuvant aromatase inhibitor therapy. The recurrence is fully exised and receives definitive local therapy. The preferred ongoing endocrine treatment is:
1. None
2. Switch to exemestane from NSAIs, or vice versa
3. Continue AI with CDK4/6 inhibitors
4. Switch to fulvestrant
5. Switch to fulvestrant and CDK4/6 inhibitors
6. Switch to tamoxifen
7. Switch to tamoxifen and CDK4/6 inhibitors
8. Abstain
SGBCC Expert Vote:
Hormone Therapy After Local-Regional Recurrence During AI Adjuvant Therapy in a Patient Who Did Not Receive Adjuvant Chemotherapy Initially
(5)A patient has developed isolated local regional recurrence while on adjuvant aromatase inhibitor therapy. The recurrence is fully exised and receives definitive local therapy. The tumor is strongly ER positive and HER2 negative. When originally diagnosed, she had notreceived adjuvant chemotherapy. Would you recommend adjuvant chemotherapy?
1. Yes
2. No
3. Abstain
SGBCC Expert Vote:
Determining Chemotherapy Based on Genetic Testing After Local-Regional Recurrence During AI Adjuvant Therapy in a Patient Diagnosed with Breast Cancer Four Years Ago
(6)A patient has developed isolated local regional recurrence 4 years after initial diagnosis while on adjuvant aromatase inhibitor therapy. The tumor is strongly ER positive and HER2 negative. A staging work up is negative. The recurrence is fully exised and receives definitive local therapy. When originally diagnosed, she had not received adjuvant chemotherapy.Would you recommend genomic signature testing to decide whether to receive chemotherapy?
1. Yes, to determine if chemotherapy is suitable
2. No, because we would recommend chemotherapy regardless of ET resistance
3. No, because I do not recommend chemotherapy
4. No, because clinical decisions can be based on other factors (grading, Ki67, PR status, age)
5. Depends on the size of the recurrent lesion
6. Abstain
SGBCC Expert Vote:
SGBCC Expert Voting, which one do you pick?
Let’s experience the atmosphere of early breast cancer treatment decisions in St. Gallen together. Due to formatting limitations, the question stem has been abbreviated, and specific content can be referenced in the above text.
1. TNBC after AC/T neoadjuvant therapy, intraoperative SLN (sentinel lymph node) with 1/3 macrometastases, do you recommend axillary lymph node dissection (AxLND) or axillary radiation therapy (AxRT)? (Select one)
– Treatment choice: AxLND
– Treatment choice: AxRT
– Both
– Neither
– Abstain
2. Postmenopausal, ER+/HER2-, cN0 (clinically lymph node-negative), lesions in adjacent quadrants on the same side, dual incisions for tumor removal, do you choose:
– No breast reconstruction after breast removal
– Breast reconstruction after breast removal
– Removal of both breasts
– Abstain
3. In the case of a same-side recurrence, tumor size less than 2 cm, 3 cm from the nipple, what do you recommend? (Select one)
– Breast removal
– Breast-conserving surgery
– Breast-conserving surgery with radiation
– Abstain
4. Recurrence during AI (Aromatase Inhibitor) adjuvant therapy, after local treatment, what is the preferred hormonal therapy? (Select one)
– None
– Switch to exemestane from NSAIs (Non-Steroidal Aromatase Inhibitors), or vice versa
– Continue AI with CDK4/6 inhibitors
– Switch to fulvestrant
– Switch to fulvestrant and CDK4/6 inhibitors
– Switch to tamoxifen
– Switch to tamoxifen and CDK4/6 inhibitors
– Abstain
5. Recurrence during AI adjuvant therapy, no adjuvant chemotherapy received at the initial diagnosis, do you recommend adjuvant chemotherapy now? (Select one)
– Yes
– No
– Abstain
6. Recurrence in the 4th year of AI adjuvant therapy, no adjuvant chemotherapy received at the initial diagnosis, do you recommend genetic testing now? (Select one)
– Yes, to determine if chemotherapy is suitable
– No, because we would recommend chemotherapy regardless of ET (Endocrine Therapy) resistance
– No, because I do not recommend chemotherapy
– No, because clinical decisions can be based on other factors (grading, Ki67, PR status, age)
– Depends on the size of the recurrent lesion
– Abstain
“SGBCC Voting Scene (Photo:Maple Leaf)”
