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CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2025; 85(07): 677-693
DOI: 10.1055/a-2612-3790
GebFra Science
Review/Übersicht

Treatment of Patients with Early Breast Cancer

19th St. Gallen International Breast Cancer Consensus Discussed against the Background of German Treatment Recommendations Artikel in mehreren Sprachen: English | deutsch
Michael Untch   *
1   Medical School Berlin, Klinik für Gynäkologie und Geburtshilfe, Interdisziplinäres Brustzentrum, HELIOS Klinikum Berlin Buch, Berlin, Germany
,
Maggie Banys-Paluchowski   *
2   Klinik für Frauenheilkunde und Geburtshilfe, Brustzentrum, Campus Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
,
Sara Y. Brucker   **
3   Universitäts-Frauenklinik Tübingen, Tübingen, Germany
,
Carsten Denkert   **
4   Institut für Pathologie, Philipps-Universität Marburg und Universitätsklinikum Marburg (UKGM), Marburg, Germany
,
Peter A. Fasching   *
5   Frauenklinik des Universitätsklinikums Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Germany
,
Renate Haidinger   P
6   Brustkrebs Deutschland e. V., Hohenbrunn bei München, Germany
,
Nadia Harbeck   *   **
7   Brustzentrum, Frauenklinik, CCC München, LMU Klinikum München, München, Germany
,
Wolfgang Janni   *   **
8   Universitätsfrauenklinik Ulm, Ulm, Germany
,
David Krug   *
9   Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
,
Sibylle Loibl   **
10   German Breast Group (GBG), Neu-Isenburg; Goethe Universität, Frankfurt am Main, Germany
,
Diana Lüftner   *
11   Immanuel Klinik Märkische Schweiz, Buckow & Immanuel Klinik Rüdersdorf, Medizinische Hochschule Brandenburg, Rüdersdorf bei Berlin, Germany
,
Laura Michel   **
12   Gynäkologische Onkologie, Nationales Centrum für Tumorerkrankungen (NCT) Heidelberg, Heidelberg, Germany
,
Eva Schumacher-Wulf   P
13   Mamma Mia! Brustkrebsmagazin, Köln, Germany
,
Christine Solbach   **
14   Klinik für Frauenheilkunde und Geburtshilfe; Brustzentrum, Universitätsmedizin Frankfurt, Frankfurt am Main, Germany
,
Rachel Würstlein   *
15   Brustzentrum, Frauenklinik, LMU Klinikum München, München, Germany
,
Jens Huober   *   **
16   HOCH, Brustzentrum Kantonsspital St. Gallen, St. Gallen, Switzerland
,
Nina Ditsch   *
17   Frauenheilkunde, Geburtshilfe und Senologie, Medizinische Fakultät, Universität Augsburg, Brustzentrum, Universitätsklinikum Augsburg, Augsburg, Germany
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Abstract

This yearʼs 19th St. Gallen (SG) consensus conference on the treatment of patients with early breast cancer (SGBCC: St. Gallen Breast Cancer Conference) is based on numerous patient examples, each with different variables, to reflect the increasingly personalized treatment decision for early breast cancer. More than ever, not only breast cancer subtype, performance status, age and life expectancy are considered as individual factors, but various molecular and genetic variables are also part of the treatment decision. In this manuscript, the SGBCC voting results are discussed by a German group of breast cancer specialists in the context of the recently (2025) updated treatment recommendations of the Commission of the Gynecological Oncology Working Group (AGO Mamma). The German treatment recommendations are based on current evidence. As the international panel of the SGBCC consists of experts from different countries and disciplines, the votes represent an international cross-section of opinions. Therefore, it is useful to discuss the voting results with respect to current German treatment guidelines.

Keywords

St. Gallen Consensus 2025 - early breast cancer - genetics - surgery - radiotherapy - (neo)adjuvant systemic therapy - survivorship

* Writing Committee


** St. Gallen panel members


P Patient representative




Publikationsverlauf

Eingereicht: 29. April 2025

Angenommen nach Revision: 12. Mai 2025

Artikel online veröffentlicht:
25. Juni 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

  • References/Literatur

  • 1 AGO Kommission Mamma. Diagnostik und Therapie früher und fortgeschrittener Mammakarzinome. März 2025. Zugriff am 14. Juni 2025 unter: https://www.ago-online.de/fileadmin/ago-online/downloads/_leitlinien/kommission_mamma/2025/AGO_2025D_Gesamtdatei.pdf
  • 2 Park-Simon T-W, Müller V, Albert U-S. et al. AGO Recommendations for the Diagnosis and Treatment of Patients with Early Breast Cancer: Update 2025. Breast Care (Basel) 2025; 1-30
    CrossrefPubMedSuche in Google Scholar
  • 3 Ditsch N. et al. Update Breast Cancer 2025 Part 1 – Expert Opinions of Early Stage Breast Cancer Therapies. Geburtshilfe Frauenheilkd 2025; (submitted)
    PubMedSuche in Google Scholar
  • 4 Meattini I, Coles CE, Tramm T. et al. Biomarker-Directed Radiotherapy in Breast Cancer: A Narrative Review. JAMA Oncol 2025; 11: 329-339
    CrossrefPubMedSuche in Google Scholar
  • 5 Reimer T, Stachs A, Veselinovic K. et al. Axillary Surgery in Breast Cancer – Primary Results of the INSEMA Trial. N Engl J Med 2025; 392: 1051-1064
    CrossrefPubMedSuche in Google Scholar
  • 6 de Boniface J, Filtenborg Tvedskov T, Rydén L. et al. Omitting Axillary Dissection in Breast Cancer with Sentinel-Node Metastases. N Engl J Med 2024; 390: 1163-1175
    CrossrefPubMedSuche in Google Scholar
  • 7 Kunkler I. Does postmastectomy radiotherapy in ‘intermediate-risk’ breast cancer impact overall survival? 10 year results of the BIG 2-04 MRC randomized trial on behalf of the SUPREMO trial investigators. Texas/USA: San Antonio; 2024
    Suche in Google Scholar
  • 8 Krug D, Baumann R, Combs SE. et al. Moderate hypofractionation remains the standard of care for whole-breast radiotherapy in breast cancer: Considerations regarding FAST and FAST-Forward. Strahlenther Onkol 2021; 197: 269-280
    CrossrefPubMedSuche in Google Scholar
  • 9 Murray Brunt A, Haviland JS, Wheatley DA. et al. Hypofractionated breast radiotherapy for 1 week versus 3 weeks (FAST-Forward): 5-year efficacy and late normal tissue effects results from a multicentre, non-inferiority, randomised, phase 3 trial. Lancet 2020; 395: 1613-1626
    CrossrefPubMedSuche in Google Scholar
  • 10 Borm KJ, Hörner-Rieber J, Duma NM. et al. De-escalation strategies in early breast cancer: implications of sentinel lymph node biopsy omission for adjuvant radiotherapy. Strahlenther Onkol 2025;
    CrossrefPubMedSuche in Google Scholar
  • 11 Mamounas EP, Bandos H, White JR. et al. NRG Oncology/NSABP B-51/RTOG 1304: Phase III trial to determine if chest wall and regional nodal radiotherapy (CWRNRT) post mastectomy (Mx) or the addition of RNRT to whole breast RT post breast-conserving surgery (BCS) reduces invasive breast cancer recurrence-free interval (IBCR-FI) in patients (pts) with pathologically positive axillary (PPAx) nodes who are ypN0 after neoadjuvant chemotherapy (NC). JCO 2019; 37: TPS600
    CrossrefPubMedSuche in Google Scholar
  • 12 Boughey JC, Suman VJ, Mittendorf EA. et al. Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA 2013; 310: 1455-1461
    CrossrefPubMedSuche in Google Scholar
  • 13 Meattini I. Exclusive endocrine therapy or radiation therapy in women aged 70+ years with luminal-like early breast cancer (EUROPA): preplanned interim analysis of a randomized phase 3 trial [GS2-01]. Texas/USA: San Antonio; 2024
    Suche in Google Scholar
  • 14 Schmid P, Cortes J, Dent R. et al. Overall Survival with Pembrolizumab in Early-Stage Triple-Negative Breast Cancer. N Engl J Med 2024; 391: 1981-1991
    CrossrefPubMedSuche in Google Scholar
  • 15 Tarantino P, Leone J, Vallejo CT. et al. Prognosis and trends in chemotherapy use for patients with stage IA triple-negative breast cancer (TNBC): A population-based study. JCO 2023; 41: 510
    CrossrefPubMedSuche in Google Scholar
  • 16 Mukhtar RA, Hoskin TL, Habermann EB. et al. Changes in Management Strategy and Impact of Neoadjuvant Therapy on Extent of Surgery in Invasive Lobular Carcinoma of the Breast: Analysis of the National Cancer Database (NCDB). Ann Surg Oncol 2021; 28: 5867-5877
    CrossrefPubMedSuche in Google Scholar
  • 17 de Gregorio A, Janni W, Friedl TWP. et al. The impact of anthracyclines in intermediate and high-risk HER2-negative early breast cancer-a pooled analysis of the randomised clinical trials PlanB and SUCCESS C. Br J Cancer 2022; 126: 1715-1724
    CrossrefPubMedSuche in Google Scholar
  • 18 Gougis P, Hamy A-S, Jochum F. et al. Immune Checkpoint Inhibitor Use During Pregnancy and Outcomes in Pregnant Individuals and Newborns. JAMA Netw Open 2024; 7: e245625
    CrossrefPubMedSuche in Google Scholar
  • 19 Tutt A, Garber JE, Kaufman B. et al. OlympiA: A phase III, multicenter, randomized, placebo-controlled trial of adjuvant olaparib after (neo)adjuvant chemotherapy in patients with germline BRCA1/2 mutations and high-risk HER2-negative early breast cancer. JCO 2021; 39: LBA1
    CrossrefPubMedSuche in Google Scholar
  • 20 Garber JE. Pre-specified analyses of IDFS, DDFS and OS10 years from First Patient In (FPI) in the OlympiA trial of adjuvant olaparib in germline BRCA1/2 mutation-associated breast cancer [GS1-09]. Texas/USA: San Antonio; 2024
    Suche in Google Scholar
  • 21 Rugo HS, Llombart-Cussac A, Andre F. et al. KEYLYNK-009: A phase II/III, open-label, randomized study of pembrolizumab (pembro) plus olaparib vs. pembro plus chemotherapy after induction with first-line pembro plus chemotherapy in patients with locally recurrent inoperable or metastatic triple-negative breast cancer (TNBC). JCO 2020; 38: TPS596
    CrossrefPubMedSuche in Google Scholar
  • 22 Rugo H, Robson M, Im S-A. et al. Abstract GS01-05: Pembrolizumab + Olaparib vs. Pembrolizumab + Chemotherapy After Induction With Pembrolizumab + Chemotherapy for Locally Recurrent Inoperable or Metastatic TNBC: Randomized Open-Label Phase 2 KEYLYNK-009 Study. Cancer Research 2024; 84: GS01-05
    CrossrefPubMedSuche in Google Scholar
  • 23 Nederlof I. Neoadjuvant nivolumab/relatlimab or nivolumab/ipilimumab in triple negative breast cancer with high tumor-infiltrating lymphocytes (TILs). Barcelona/Spanien: 2024
    Suche in Google Scholar
  • 24 Tolaney SM, Tarantino P, Graham N. et al. Adjuvant paclitaxel and trastuzumab for node-negative, HER2-positive breast cancer: final 10-year analysis of the open-label, single-arm, phase 2 APT trial. Lancet Oncol 2023; 24: 273-285
    CrossrefPubMedSuche in Google Scholar
  • 25 Geyer CE, Untch M, Huang C-S. et al. Survival with Trastuzumab Emtansine in Residual HER2-Positive Breast Cancer. N Engl J Med 2025; 392: 249-257
    CrossrefPubMedSuche in Google Scholar
  • 26 Loibl S, Huang C-S, Mano MS. et al. Adjuvant trastuzumab emtansine in HER2-positive breast cancer patients with HER2-negative residual invasive disease in KATHERINE. NPJ Breast Cancer 2022; 8: 106
    CrossrefPubMedSuche in Google Scholar
  • 27 Waks AG, Villacampa G, Brunet LP. et al. 126MO HER2DX and pathological complete response in HER2-positive breast cancer: A combined analysis of 4 neoadjuvant studies. ESMO Open 2023; 8: 101465
    CrossrefPubMedSuche in Google Scholar
  • 28 Villacampa G, Tung NM, Pernas S. et al. Association of HER2DX with pathological complete response and survival outcomes in HER2-positive breast cancer. Ann Oncol 2023; 34: 783-795
    CrossrefPubMedSuche in Google Scholar
  • 29 Coates AS, Winer EP, Goldhirsch A. et al. Tailoring therapies–improving the management of early breast cancer: St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2015. Ann Oncol 2015; 26: 1533-1546
    CrossrefPubMedSuche in Google Scholar
  • 30 Lux MP, Ciani O, Dunlop WCN. et al. The Impasse on Overall Survival in Oncology Reimbursement Decision-Making: How Can We Resolve This?. Cancer Manag Res 2021; 13: 8457-8471
    CrossrefPubMedSuche in Google Scholar
  • 31 Harbeck N, Gluz O, Kuemmel S. et al. Endocrine therapy alone in patients with intermediate or high-risk luminal early breast cancer (0–3 lymph nodes), Recurrence Score < 26 and Ki67 response after preoperative endocrine therapy: Primary outcome results from the WSG-ADAPT HR+/HER2- trial. Cancer Res 2021; 81 (4_Supplement): GS4-04
    CrossrefPubMedSuche in Google Scholar
  • 32 Mengel M, von Wasielewski R, Wiese B. et al. Inter-laboratory and inter-observer reproducibility of immunohistochemical assessment of the Ki-67 labelling index in a large multi-centre trial. J Pathol 2002; 198: 292-299
    CrossrefPubMedSuche in Google Scholar
  • 33 Johnston SRD, Harbeck N, Hegg R. et al. Abemaciclib Combined With Endocrine Therapy for the Adjuvant Treatment of HR+, HER2-, Node-Positive, High-Risk, Early Breast Cancer (monarchE). JCO 2020; 38: 3987-3998
    CrossrefPubMedSuche in Google Scholar
  • 34 Slamon D, Lipatov O, Nowecki Z. et al. Ribociclib plus Endocrine Therapy in Early Breast Cancer. N Engl J Med 2024; 390: 1080-1091
    CrossrefPubMedSuche in Google Scholar
  • 35 Robson ME, Tung N, Conte P. et al. OlympiAD final overall survival and tolerability results: Olaparib versus chemotherapy treatment of physicianʼs choice in patients with a germline BRCA mutation and HER2-negative metastatic breast cancer. Ann Oncol 2019; 30: 558-566
    CrossrefPubMedSuche in Google Scholar
  • 36 Reimer T, Gluz O, Nitz U. et al. Prospektive Phase-III PlanB-Studie: 5 Jahres Daten zum prognostischen Stellenwert von 21-Gen Recurrence-Score, zentralpathologischem Grading, ER, PR, Ki-67 Review beim frühem Hochrisiko HR+/HER2-negativen Mammakarzinom. Senologie 2016;
    Thieme ConnectPubMedSuche in Google Scholar
  • 37 Kalinsky K, Barlow WE, Gralow JR. et al. 21-Gene Assay to Inform Chemotherapy Benefit in Node-Positive Breast Cancer. N Engl J Med 2021; 385: 2336-2347
    CrossrefPubMedSuche in Google Scholar
  • 38 Janni W, Untch M, Harbeck N. et al. Systematic literature review and trial-level meta-analysis of aromatase inhibitors vs. tamoxifen in patients with HR+/HER2- early breast cancer. Breast 2025; 81: 104429
    CrossrefPubMedSuche in Google Scholar
  • 39 Hortobagyi GN, Lacko A, Sohn J. et al. A phase III trial of adjuvant ribociclib plus endocrine therapy versus endocrine therapy alone in patients with HR-positive/HER2-negative early breast cancer: final invasive disease-free survival results from the NATALEE trial. Ann Oncol 2025; 36: 149-157
    CrossrefPubMedSuche in Google Scholar
  • 40 Untch M, Pérol D, Mayer EL. et al. Disease-free survival as a surrogate for overall survival in HR+/HER2- early breast cancer: A correlation analysis. Eur J Cancer 2024; 202: 113977
    CrossrefPubMedSuche in Google Scholar
  • 41 Fasching PA, Stroyakovskiy D, Yardeley D. et al. Adjuvant ribociclib (RIB) plus nonsteroidal aromatase inhibitor (NSAI) in patients (Pts) with HR+/HER2- early breast cancer (EBC): 4-year outcomes from the NATALEE trial [LBA13]. Ann Oncol 2025; 35 (Suppl. 2) S1207
    PubMedSuche in Google Scholar
  • 42 Michel LL, Schwarz D, Romar P. et al. Efficacy of Hand Cooling and Compression in Preventing Taxane-Induced Neuropathy: The POLAR Randomized Clinical Trial. JAMA Oncol 2025;
    CrossrefPubMedSuche in Google Scholar
  • 43 Khan SA, Zhao F, Goldstein LJ. et al. Early Local Therapy for the Primary Site in De Novo Stage IV Breast Cancer: Results of a Randomized Clinical Trial (EA2108). JCO 2022; 40: 978-987
    CrossrefPubMedSuche in Google Scholar
  • 44 Piroth MD, Krug D, Feyer P. et al. Oligometastasis in breast cancer-current status and treatment options from a radiation oncology perspective. Strahlenther Onkol 2022; 198: 601-611
    CrossrefPubMedSuche in Google Scholar