Behandlung des frühen Mammakarzinoms – 18. Internationaler St.-Gallen-Konsens vor dem Hintergrund der aktuellen deutschen Therapieempfehlungen diskutiert

Michael Untch; Maggie Banys-Paluchowski; Sara Y. Brucker; Wilfried Budach; Carsten Denkert; Nina Ditsch; Peter A. Fasching; Renate Haidinger; Jörg Heil; Christian Jackisch; Wolfgang Janni; Hans-Christian Kolberg; David Krug; Sibylle Loibl; Diana Lüftner; Marion van Mackelenbergh; Julia C. Radosa; Toralf Reimer; Manfred Welslau; Rachel Würstlein; Nadia Harbeck; Jens Huober

doi:10.1055/a-2141-4863

Senologie - Zeitschrift für Mammadiagnostik und -therapie, Table of Contents

Senologie - Zeitschrift für Mammadiagnostik und -therapie 2023; 20(03): 241-256
DOI: 10.1055/a-2141-4863

Übersicht

Behandlung des frühen Mammakarzinoms – 18. Internationaler St.-Gallen-Konsens vor dem Hintergrund der aktuellen deutschen Therapieempfehlungen diskutiert

Treatment of Early Breast Cancer – The 18^th St. Gallen International Breast Cancer Consensus Conference against the Background of Current German Treatment Recommendations

Michael Untch^*

¹Klinik für Gynäkologie und Geburtshilfe, interdisziplinäres Brustzentrum, HELIOS Klinikum Berlin Buch, Berlin

,

Maggie Banys-Paluchowski^*

²Klinik für Frauenheilkunde und Geburtshilfe, Brustzentrum, Campus Lübeck, Universitätsklinikum Schleswig-Holstein, Lübeck

,

Sara Y. Brucker^**^#

³Universitäts-Frauenklinik Tübingen, Tübingen

,

Wilfried Budach^**

⁴Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Düsseldorf, Düsseldorf

,

Carsten Denkert^**^#

⁵Institut für Pathologie, Philipps-Universität Marburg und Universitätsklinikum Marburg (UKGM), Marburg

,

Nina Ditsch^*

⁶Klinik für Frauenheilkunde und Geburtshilfe, Brustzentrum, Universitätsklinikum Augsburg, Augsburg

,

Peter A. Fasching^*

⁷Frauenklinik des Universitätsklinikums Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen

,

Renate Haidinger^**

⁸Brustkrebs Deutschland e. V., Hohenbrunn bei München

,

Jörg Heil^**^#

⁹Brustzentrum Heidelberg, Klinik St. Elisabeth, Heidelberg

¹⁰Medizinische Fakultät Ruprecht-Karls-Universität Heidelberg, Heidelberg

,

Christian Jackisch^*

¹¹Klinik für Gynäkologie und Geburtshilfe, Sana-Klinikum Offenbach GmbH, Offenbach

,

Wolfgang Janni^*

¹²Universitätsfrauenklinik Ulm, Ulm

,

Hans-Christian Kolberg^**

¹³Klinik für Gynäkologie und Geburtshilfe, Marienhospital Bottrop gGmbH, Bottrop

,

David Krug^*

¹⁴Klinik für Strahlentherapie (Radioonkologie), Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel

,

Sibylle Loibl^**^#

¹⁵German Breast Group (GBG), Neu-Isenburg

¹⁶Centrum für Hämatologie und Onkologie Bethanien, Frankfurt am Main

,

Diana Lüftner^*

¹⁷Immanuel Klinik Märkische Schweiz, Buckow

¹⁸Immanuel Klinik Rüdersdorf, Medizinische Hochschule Brandenburg, Rüdersdorf bei Berlin

,

Marion van Mackelenbergh^**

¹⁹Gynäkologie und Geburtshilfe, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Kiel

,

Julia C. Radosa^**

²⁰Klinik für Gynäkologie, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar

,

Toralf Reimer^**

²¹Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt Rostock, Rostock

,

Manfred Welslau^**

²²Onkologie Aschaffenburg, Hämato-Onkologische Schwerpunktpraxis am Klinikum Aschaffenburg-Alzenau, Aschaffenburg

,

Rachel Würstlein^**

²³Brustzentrum, Frauenklinik, LMU Klinikum München, München

,

Nadia Harbeck^*^#

²³Brustzentrum, Frauenklinik, LMU Klinikum München, München

,

Jens Huober^*^#

²⁴Brustzentrum Kantonsspital St. Gallen, St. Gallen, Schweiz

› Author Affiliations

Abstract

Zusammenfassung

Die diesjährige 18. St.-Gallen-(SG-)Konsensus-Konferenz zur Behandlung des frühen Mammakarzinoms (SGBCC: St. Gallen Breast Cancer Conference) fokussierte auf praxisorientierte Fragestellungen. Die individuelle Krankheitssituation und Nutzen-Risiko-Abwägung wurden sehr detailliert diskutiert. Wie schon in den vergangenen Jahren hat auch dieses Jahr eine deutsche Arbeitsgruppe führender Brustkrebsexpertinnen und -experten die Ergebnisse der internationalen SGBCC 2023 vor dem Hintergrund der deutschen Therapieempfehlungen – speziell der aktualisierten Therapieempfehlungen der Kommission Mamma der Arbeitsgemeinschaft Gynäkologische Onkologie e. V. (AGO) – für den Klinikalltag in Deutschland diskutiert. Die deutschen Therapieempfehlungen der AGO Mamma 2023 basieren auf der aktuellen Evidenz. Der Abgleich mit dem klinischen Vorgehen in Deutschland hat sich bewährt, da sich das SGBCC-Panel aus Expertinnen und Experten unterschiedlicher Länder und Fachdisziplinen zusammensetzt, weshalb länderspezifische Besonderheiten in die SGBCC-Empfehlungen einfließen können.

Abstract

This yearʼs 18^th St. Gallen (SG) consensus conference on the treatment of early breast cancer (SGBCC: St. Gallen International Breast Cancer Conference) focused on practice-oriented questions. The individual situation and risk-benefit assessment were discussed in great detail. As in previous years, a German working group of leading breast cancer experts presented the results of the international SGBCC 2023 against the background of German treatment recommendations – especially the updated treatment recommendations of the Arbeitsgemeinschaft Gynäkologische Onkologie e. V. (AGO) – for everyday clinical practice in Germany. The German treatment recommendations of AGO Mamma 2023 are based on the current evidence. The comparison with the clinical approach in Germany has proven useful, as the SGBCC panel consists of experts from different countries and disciplines. That is why country-specific characteristics can be incorporated into the SGBCC recommendations.

Schlüsselwörter

St. Gallen Konsensus 2023 - frühes Mammakarzinom - Genetik - Pathologie - Operation - Strahlentherapie - (neo)adjuvante Systemtherapie

Key words

St. Gallen Consensus 2023 - early-onset breast cancer - genetics - pathology - surgery - radiotherapy - (neo)adjuvant systemic therapy

Full Text

References

Literatur
1 AGO Kommission Mamma. Diagnostik und Therapie früher und fortgeschrittener Mammakarzinome (März 2023). Stand: 15.04.2023. Im Internet (Stand: 30.07.2023): https://www.ago-online.de/leitlinienempfehlungen/leitlinien-empfehlungen/kommission-mamma
2 Tjoung-Won PS, Müller V, Jackisch C. et al. AGO Recommendations for the Diagnosis and Treatment of Patients with Early Breast Cancer (EBC): Update 2023. Breast Care 2023;
3 Patridge AH, Niman SM, Ruggeri M. Interrupting Endocrine Therapy to Attempt Pregnancy after Breast Cancer. N Engl J Med 2023; 388: 1645-1656
4 Pan H, Gray R, Braybrooke J. et al. 20-Year Risks of Breast-Cancer Recurrence after Stopping Endocrine Therapy at 5 Years. N Engl J Med 2017; 377: 1836-1846
5 Nelson DR, Brown J, Morikawa A. et al. Breast cancer-specific mortality in early breast cancer as defined by high-risk clinical and pathologic characteristics. PLoS One 2022; 17: e0264637
6 Yadav S. Population-based Estimates of Contralateral Breast Cancer Risk among Carriers of Germline Pathogenic Variants in ATM, BRCA1, BRCA2, CHEK2 and PALB2. San Antonio Breast Cancer Symposium 2022; Abstract No. GS4-04
7 Yadav S, Hu C, Hart SN. et al. Evaluation of Germline Genetic Testing Criteria in a Hospital-Based Series of Women With Breast Cancer. J Clin Oncol 2020; 38: 1409-1418
8 Tung NM, Robson ME, Ventz S. et al. TBCRC048: Phase II Study of Olaparib for Metastatic Breast Cancer and Mutations in Homologous Recombination-Related Genes. J Clin Oncol 2020; 38: 4274-4282
9 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. J Clin Oncol 2021; 39: LBA1
10 Tutt ANJ, Garber JE, Kaufman B. et al. Adjuvant Olaparib for Patients with BRCA1- or BRCA2-Mutated Breast Cancer. N Engl J Med 2021; 384: 2394-2405
11 de Censi A, Lazzeroni M, Puntoni M. 10-year results of a phase 3 trial of low-dose tamoxifen in non-invasive breast cancer. San Antonio Breast Cancer Symposium 2022; Abstract No. GS4-08
12 Reinisch M, Seiler S, Hauzenberger T. et al. Efficacy of Endocrine Therapy for the Treatment of Breast Cancer in Men: Results from the MALE Phase 2 Randomized Clinical Trial. JAMA Oncol 2021; 7: 565-572
13 Offersen B, Alsner J, Nielsen HM. et al. OC-0102 DBCG phase III randomized trial of hypo- vs. standard fractionated RT in 2879 pN+ breast cancer pts. Radiotherapy and Oncology 2022; 170: S76-S77
14 Bartelink H, Maingon P, Poortmans P. et al. Whole-breast irradiation with or without a boost for patients treated with breast-conserving surgery for early breast cancer: 20-year follow-up of a randomised phase 3 trial. Lancet Oncol 2015; 16: 47-56
15 Chua BH, Link EK, Kunkler IH. et al. Radiation doses and fractionation schedules in non-low-risk ductal carcinoma in situ in the breast (BIG 3-07/TROG 07.01): a randomised, factorial, multicentre, open-label, phase 3 study. Lancet 2022; 400: 431-440
16 Kunkler IH, Williams LJ, Jack WJL. et al. Breast-conserving surgery with or without irradiation in women aged 65 years or older with early breast cancer (PRIME II): a randomised controlled trial. Lancet Oncol 2015; 16: 266-273
17 Kunkler I, Williams LJ, Jack W. et al GS2-03. Prime 2 randomised trial (postoperative radiotherapy in minimum-risk elderly): Wide local excision and adjuvant hormonal therapy ± whole breast irradiation in women =/> 65 years with early invasive breast cancer: 10 year results. San Antonio Breast Cancer Symposium 2020; Abstract No. GS2-03
18 Moo T-A, Edelweiss M, Hajiyeva S. et al. Is Low-Volume Disease in the Sentinel Node After Neoadjuvant Chemotherapy an Indication for Axillary Dissection?. Ann Surg Oncol 2018; 25: 1488-1494
19 Hartmann S, Kühn T, Hauptmann M. et al. Axillary Staging after Neoadjuvant Chemotherapy for Initially Node-Positive Breast Carcinoma in Germany: Initial Data from the AXSANA study. Geburtshilfe Frauenheilkd 2022; 82: 932-940
20 Boughey JC, Rosenkranz KM, Ballman KV. Impact of breast conservation therapy on local recurrence in patients with multiple ipsilateral breast cancer – Results from ACOSOG Z11102 (Alliance). San Antonio Breast Cancer Symposium 2022; Abstract No. GS4-01
21 Gnant M, Fitzal F, Rinnerthaler G. et al. Duration of Adjuvant Aromatase-Inhibitor Therapy in Postmenopausal Breast Cancer. N Engl J Med 2021; 385: 395-405
22 Goss PE, Ingle JN, Pritchard KI. et al. Extending Aromatase-Inhibitor Adjuvant Therapy to 10 Years. N Engl J Med 2016; 375: 209-219
23 Gray RG, Rea D, Handley K. et al. aTTom: Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years in 6953 women with early breast cancer. J Clin Oncol 2013; 31: 5
24 Davies C, Pan H, Godwin J. et al. Long-term effects of continuing adjuvant tamoxifen to 10 years versus stopping at 5 years after diagnosis of oestrogen receptor-positive breast cancer: ATLAS, a randomised trial. Lancet 2013; 381: 805-816
25 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). J Clin Oncol 2020; 38: 3987-3998
26 Harbeck N, Rastogi P, Martin M. et al. Adjuvant abemaciclib combined with endocrine therapy for high-risk early breast cancer: updated efficacy and Ki-67 analysis from the monarchE study. Ann Oncol 2021; 32: 1571-1581
27 OʼShaughnessy J, Rastogi P, Harbeck N. Adjuvant abemaciclib combined with endocrine therapy: Updated results from monarchE. ESMO Virtual Plenary Session, October 14, 2021
28 Smith I, Robertson J, Kilburn L. et al. Long-term outcome and prognostic value of Ki67 after perioperative endocrine therapy in postmenopausal women with hormone-sensitive early breast cancer (POETIC): an openlabel, multicentre, parallel-group, randomised, phase 3 trial. Lancet Oncol 2020; 21: 1443-1454
29 Nitz UA, Gluz O, Kümmel S. et al. Endocrine Therapy Response and 21-Gene Expression Assay for Therapy Guidance in HR+/HER2- Early Breast Cancer. J Clin Oncol 2022; 40: 2557-2567
30 Piccart M, vanʼt Veer LJ, Poncet C. et al. 70-gene signature as an aid for treatment decisions in early breast cancer: updated results of the phase 3 randomised MINDACT trial with an exploratory analysis by age. Lancet Oncol 2021; 22: 476-488
31 Sparano JA, Gray RJ, Ravdin PM. et al. Clinical and Genomic Risk to Guide the Use of Adjuvant Therapy for Breast Cancer. N Engl J Med 2019; 380: 2395-2405
32 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
33 Gluz O, Nitz U, Christgen M. Impact of age, recurrence score and ovarian function suppression on endocrine response to short preoperative endocrine therapy: Analysis of ADAPT and ADAPTcycle trials. Ann Oncol 2022; 33: S808-S869
34 Sparano J, Gray RJ, Makower D. Trial Assigning Individualized Options for Treatment (TAILORx): An Update Including 12-Year Event Rates. San Antonio Breast Cancer Symposium 2022; Abstract No. GS1-05
35 Francis PA, Regan MM, Fleming GF. et al. Adjuvant ovarian suppression in premenopausal breast cancer. N Engl J Med 2015; 372: 436-446
36 Schmid P, Cortes J, Dent R. et al. Event-free Survival with Pembrolizumab in Early Triple-Negative Breast Cancer. N Engl J Med 2022; 386: 556-567
37 Schmid P, Cortes J, Pusztai L. et al. Pembrolizumab for Early Triple-Negative Breast Cancer. N Engl J Med 2020; 382: 810-821
38 Loibl S, Schneeweiss A, Huober J. et al. Neoadjuvant durvalumab improves survival in early triple-negative breast cancer independent of pathological complete response. Ann Oncol 2022; 33: 1149-1158
39 Loibl S, Jackisch C, Rastogi P. et al. GeparDouze/NSABP B-59: A randomized double-blind phase III clinical trial of neoadjuvant chemotherapy with atezolizumab or placebo in patients with triple negative breast cancer (TNBC) followed by adjuvant atezolizumab or placebo. Ann Oncol 2019; 30: iii38
40 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
41 Tarantino P, Tayob N, Dang CT. Adjuvant Trastuzumab Emtansine versus Paclitaxel plus Trastuzumab for Stage I HER2+ breast cancer: 5-year results and correlative analyses from ATEMPT (TBCRC033). San Antonio Breast Cancer Symposium 2022; Abstract No. PD18-01
42 Loibl S, Jassem J, Sonnenblick A. et al. VP6-2022: Adjuvant pertuzumab and trastuzumab in patients with early HER-2 positive breast cancer in APHINITY: 8.4 yearsʼ follow-up. Ann Oncol 2022; 33: 986-987
43 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
44 Domchek SM, Postel-Vinay S, Im SA. et al. Olaparib and durvalumab in patients with germline BRCA-mutated metastatic breast cancer (MEDIOLA): an open-label, multicentre, phase 1/2, basket study. Lancet Oncol 2020; 21: 1155-1164
45 Konstantinopoulos PA, Waggoner S, Vidal GA. et al. Single-Arm Phases 1 and 2 Trial of Niraparib in Combination With Pembrolizumab in Patients With Recurrent Platinum-Resistant Ovarian Carcinoma. JAMA Oncol 2019; 5: 1141-1149
46 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). J Clin Oncol 2020; 38: TPS596
47 Gnant M, Pfeiler G, Steger GG. et al. Adjuvant denosumab in postmenopausal patients with hormone receptor-positive breast cancer (ABCSG-18): disease-free survival results from a randomised, doubleblind, placebo-controlled, phase 3 trial. Lancet Oncol 2019; 20: 339-351
48 Díaz-Roldán J, Eguía-Larrea M, Rubio-Sánchez T. et al. Systematic review of synchronous contralateral axillary metastases in breast cancer: really M1 disease?. Breast Cancer 2022; 29: 9-18