More breast cancer patients can benefit from adjuvant endocrine therapy: panel

NEW YORK (Reuters Health) - Adjuvant endocrine therapy should be part of treatments for most patients whose tumors have any detectable estrogen receptor, according to the 11th St. Gallen (Switzerland) expert consensus algorithm for individualized primary therapy for early breast cancer.

"The main message is to target treatments more precisely at appropriate patients," panel members Dr. Aron Goldhirsch from European Institute of Oncology, Milan, Italy, and Dr. Alan S. Coates from University of Sydney, Sydney, New South Wales, Australia, told Reuters Health. "We believe this will lead to more patients receiving adequate adjuvant endocrine therapy and fewer receiving adjuvant cytotoxics."

Dr. Goldhirsch, Dr. Coates, and colleagues met to consider the primary treatment of early breast cancer, emphasizing targeting adjuvant systemic therapies according to subgroups defined by predictive markers. The resulting algorithm, published in the June 18th online issue of the Annals of Oncology, defines thresholds for endocrine therapy, anti-HER2 therapy, and chemotherapy.

For patients with any detectable estrogen receptor, the panel recommends the inclusion of adjuvant endocrine therapy. Anti-HER2 therapy is recommended for patients with HER2-positive disease.

Most patients whose tumors lack estrogen and progesterone receptors and are HER2-negative should receive chemotherapy, the experts say, but for other patients the threshold for cytotoxic chemotherapy remains difficult to define.

Features that might support the addition of chemotherapy to endocrine therapy could include lower expression of steroid hormone receptors, grade 3 tumors, high proliferation as measured by conventional or multigene assays, and such risk factors as 4 or more axillary lymph nodes involved, extensive peritumoral vascular invasion, and tumors larger than 5 cm.

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