Adjuvant therapy for breast cancer - Report on the 10th International expert consensus conference in St. Gallen 2007: "Care despite controversies"

Treatment recommendations for operable breast cancer as determined in St. Gallen every two years are the only guidelines in the world concluded by an international panel of experts. Even if discrepancies exist due to the different backgrounds of the experts, several cornerstones for treatment decisions have become apparent. The risk classification of breast cancer is still based on the recommendations of the St. Gallen meeting 2005. HER-2 has changed from being a risk marker to a therapeutic target. The use of trastuzumab is now a new standard in adjuvant treatment settings. The evaluation of breast cancers according to their endocrine responsiveness and non-responsiveness is decisive for determining the decision for treatment. Hormonal treatment should be mandatory for all breast cancers which have an endocrine responsiveness or are at least potentially responsive and should include the risk-adapted use of an aromatase inhibitor for postmenopausal women. Tamoxifen is still a standard treatment for pre- and perimenopausal women. The additional use of a GnRH-analogue should be considered, depending on the individual risk assessment. The importance of anthracyclines and taxanes for adjuvant chemotherapy remains unchallenged. The molecular knowledge of prognostic and predictive markers is increasing and appropriate molecular test systems are currently being evaluated in large phase III trials. Thus, in the near future we can expect a more appropriate evaluation of the benefits of adjuvant therapy combined with an individual risk assessment.