Goldhirsch A, Wood W C, Gelber R D, Coates A S, Thürlimann B, Senn H-J
International Breast Cancer Study Group, Oncology Institute of Southern Switzerland, 6500 Bellinzona, Switzerland.
Ann Oncol. 2007 Jul;18(7):1133-44. doi: 10.1093/annonc/mdm271.
The 10th St Gallen (Switzerland) expert consensus meeting in March 2007 refined and extended a target-oriented approach to adjuvant systemic therapy of early breast cancer. Target definition is inextricably intertwined with the availability of target-specific therapeutic agents. Since 2005, the presence of HER2 on the cell surface has been used as an effective target for trastuzumab much as steroid hormone receptors are targets for endocrine therapies. An expert Panel reaffirmed the primary importance of determining endocrine responsiveness of the cancer as a first approach to selecting systemic therapy. Three categories were acknowledged: highly endocrine responsive, incompletely endocrine responsive and endocrine non-responsive. The Panel accepted HER2-positivity to assign trastuzumab, and noted that adjuvant trastuzumab has only been assessed together with chemotherapy. They largely endorsed previous definitions of risk categories. While recognizing the existence of several molecularly-based tools for risk stratification, the Panel preferred to recommend the use of high-quality standard histopathological assessment for both risk allocation and target identification. Chemotherapy, although largely lacking specific target information, is the only option in cases which are both endocrine receptor-negative and HER2-negative. Chemotherapy is conventionally given with or preceding trastuzumab for patients with HER2-positive disease, and may be used for patients with endocrine responsive disease in cases where the sufficiency of endocrine therapy alone is uncertain. Recommendations are provided not as specific therapy guidelines but rather as a general guidance emphasizing main principles for tailoring therapeutic choice.
2007年3月在瑞士圣加仑召开的第十届专家共识会议完善并扩展了早期乳腺癌辅助全身治疗的目标导向方法。靶点定义与靶点特异性治疗药物的可用性紧密相连。自2005年以来，细胞表面HER2的存在已被用作曲妥珠单抗的有效靶点，就如同甾体激素受体是内分泌治疗的靶点一样。一个专家小组重申，确定癌症的内分泌反应性作为选择全身治疗的首要方法至关重要。确认了三类情况：高度内分泌反应性、不完全内分泌反应性和内分泌无反应性。该小组认可HER2阳性作为使用曲妥珠单抗的指征，并指出辅助性曲妥珠单抗仅与化疗联合进行过评估。他们在很大程度上认可了之前风险类别的定义。虽然认识到存在几种基于分子的风险分层工具，但该小组更倾向于推荐使用高质量的标准组织病理学评估进行风险分类和靶点识别。化疗虽然在很大程度上缺乏特定靶点信息，但对于内分泌受体阴性且HER2阴性的病例是唯一选择。对于HER2阳性疾病患者，化疗通常与曲妥珠单抗联合使用或在其之前使用，对于内分泌反应性疾病患者，若仅靠内分泌治疗是否足够不确定，化疗也可使用。提供这些建议并非作为具体的治疗指南，而是作为强调量身定制治疗选择主要原则的一般性指导。
