Meeting Highlights: International Consensus Panel on the Treatment of Primary Breast Cancer
Authors: Richard R. Love, Aron Goldhirsch, John H. Glick, Richard D. Gelber, Alan S. Coates, Hans-Jörg Senn
Journal: Journal of Clinical Oncology (2002)

Article Tools SPECIAL DEPARTMENTS Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/JCO.2002.20.7.1955 Journal of Clinical Oncology - published online before print September 21, 2016 PMID: 11919263 Meeting Highlights: International Consensus Panel on the Treatment of Primary Breast Cancer Richard R. LovexRichard R. LoveSearch for articles by this author Aron GoldhirschxAron GoldhirschSearch for articles by this author , John H. GlickxJohn H. GlickSearch for articles by this author , Richard D. GelberxRichard D. GelberSearch for articles by this author , Alan S. CoatesxAlan S. CoatesSearch for articles by this author , Hans-Jörg SennxHans-Jörg SennSearch for articles by this author Show More University of Wisconsin Comprehensive Cancer Center, Madison, WIInternational Consensus Panel on the Treatment of Primary Breast Cancer, St Gallen, Switzerland https://doi.org/10.1200/JCO.2002.20.7.1955 First Page Full Text PDF Figures and Tables © 2002 by American Society of Clinical OncologyjcoJ Clin OncolJournal of Clinical OncologyJCO0732-183X1527-7755American Society of Clinical OncologyResponse01042002In Reply:We thank Dr Love for his remarks drawing attention to the important role of adjuvant endocrine therapies, which are, as he rightly points out, a feature of the recent report1 of the 2001 St Gallen Consensus Panel. Some of his interpretations, however, seem to overlook the endocrine effects of chemotherapy, especially in older premenopausal women.The “historical accident” to which Love refers whereby adjuvant chemotherapy has become “essential” in the United States has not been as pervasive in other parts of the world. Workers in the United Kingdom2 and elsewhere3 have emphasized the investigation of appropriate endocrine therapies.Studies to dissect and define the optimal methods of delivering adjuvant endocrine therapy are currently of high research priority. Trials investigating the value of ovarian function suppression and the need for chemotherapy in addition to endocrine therapy will be activated shortly. The International Breast Cancer Study Group (IBCSG) has proposed a suite of three trials for premenopausal women with endocrine-responsive tumors, allowing participation by those with various preconceptions. The designs are as follows: 1. SOFT (Suppression of Ovarian Function Trial: IBCSG 24-02): For women remaining premenopausal after chemotherapy or not receiving chemotherapy; tamoxifen alone versus ovarian suppression plus tamoxifen versus ovarian suppression plus exemestane. 2. TEXT (Tamoxifen and Exemstane Trial: IBCSG 25-02): For women considered to require ovarian suppression with or without chemotherapy from the start of adjuvant therapy; tamoxifen plus gonadotropin-releasing hormone analog versus exemestane plus gonadotropin-releasing hormone analog. 3. PERCHE (Premenopausal ER-Positive Chemotherapy Trial: IBCSG 26-02): For women in whom the value of chemotherapy is uncertain; ovarian suppression plus tamoxifen or exemestane versus ovarian suppression plus tamoxifen or exemestane plus chemotherapy. The United States Intergroup, the Breast International Group, and other study groups will participate in some or all of these global clinical trials, which, when taken together, will address questions that we agree remain uncertain. Whether chemotherapy provides benefit to women with endocrine-responsive tumors in addition to combined endocrine treatment with ovarian function suppression and tamoxifen has until now proved difficult to study, though one recent small trial suggests that outcomes may be similar with or without chemotherapy after ovarian suppression.4Cost considerations may be dominant in some countries, whereas in others, women and their doctors will want information on optimal treatment, including both benefits and side effects.5,6 Meanwhile, the St Gallen Panel recommendations clearly recognize the importance of defining endocrine responsiveness in the selection of appropriate adjuvant therapy for early breast cancer treatment, either on or off study. The following reply, by Goldhirsch et al, was previously published in the February 1, 2002, issue of the Journal of Clinical Oncology. It is reprinted here for the convenience of the reader. Portions were changed by the authors to reflect updates to the trials to which the letter refers. 1. Goldhirsch A, Glick JH, Gelber RD, et al: Meeting highlights: International Consensus Panel on the treatment of primary breast cancer. J Clin Oncol 19:: 3817,2001-3827, Link, Google Scholar2. Cancer Research Campaign Breast Cancer Trials Group: The effect of adjuvant tamoxifen: The latest results from the Cancer Research Campaign adjuvant breast trial. Eur J Cancer 28A:: 904,1992-907, Medline, Google Scholar3. Aebi S, Gelber S, Castiglione-Gertsch M, et al: Is chemotherapy alone adequate for young women with oestrogen-receptor-positive breast cancer? Lancet 355:: 1869,2000-1874, Crossref, Medline, Google Scholar4. International Breast Cancer Study Group: Randomized controlled trial of ovarian function suppression plus tamoxifen versus the same endocrine therapy plus chemotherapy: Is chemotherapy necessary for premenopausal women with node-positive breast cancer? First results of International Breast Cancer Study Group Trial 11-93. Breast 10:: 130,2001-138, (suppl 3) Crossref, Google Scholar5. Coates AS, Simes RJ: Patient assessment of adjuvant treatment in operable breast cancer, in Williams CJ (ed): Introducing New Treatments for Cancer: Practical, Ethical and Legal Problems (ed 1). Chichester, United Kingdom, John Wiley & Sons Ltd, pp 447,1992,-458 Google Scholar6. Houghton J, Fellowes D, Fallowfield L: Patients’ view of minimum acceptable benefits from adjuvant hormonal therapy. Breast 10:: S38,,2001 (abstr) Crossref, Medline, Google Scholar