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1、Strategiesforsubtypes—dealingwiththediversityofbreastcancer:highlightsoftheStGallenInternationalExpertConsensusonthePrimaryTherapyofEarlyBreastCancer2011A.Goldhirsch1,*,W.C.Wood2,A.S.Coates3,R.D.Gelber4,B.Thurlimann5,H.-J.Senn6&Panel¨?membersInternationalBreastCancerStudyGroup,DepartmentofMed
2、icine,EuropeanInstituteofOncology,Milan,Italy;2DepartmentofSurgery,EmoryUniversitySchoolofMedicine,N.E.Atlanta,USA;3InternationalBreastCancerStudyGroupandUniversityofSydney,Sydney,Australia;4InternationalBreastCancerStudyGroupStatisticalCenter,DepartmentofBiostatisticsandComputationalBiology,
3、Dana-FarberCancerInstitute,HarvardMedicalSchool,Boston,USA;5BreastCenter,KantonsspitalStGallen,StGallen;6TumorandBreastCenterZeTuP,StGallen,SwitzerlandReceived21April2011;accepted23May2011The12thStGallenInternationalBreastCancerConference(2011)ExpertPaneladoptedanewapproachtotheclassi?cationo
4、fpatientsfortherapeuticpurposesbasedontherecognitionofintrinsicbiologicalsubtypeswithinthebreastcancerspectrum.Forpracticalpurposes,thesesubtypesmaybeapproximatedusingclinicopathologicalratherthangeneexpressionarraycriteria.Ingeneral,systemictherapyrecommendationsfollowthesubtypeclassi?cation
5、.Thus,‘LuminalA’diseasegenerallyrequiresonlyendocrinetherapy,whichalsoformspartofthetreatmentofthe‘LuminalB’subtype.Chemotherapyisconsideredindicatedformostpatientswith‘LuminalB’,‘HumanEpidermalgrowthfactorReceptor2(HER2)positive’,and‘Triplenegative(ductal)’disease,withtheadditionoftrastuzuma
6、bin‘HER2positive’disease.Progresswasalsonotedinde?ningbettertoleratedlocaltherapiesinselectedcaseswithoutlossofef?cacy,suchasacceleratedradiationtherapyandtheomissionofaxillarydissectionunderde?nedcircumstances.Broadtreatmentrecommendationsarepresented,recognizingthatdetailedtreatmentdecision
7、sneedtoconsiderdiseaseextent,hostfactors,patientpreferences,andsocialandeconomicconstraints.Keywords:adjuvanttherapies,earlybreastcancer,StGallenConsensus,subtypesIntroductionItisnolongertenabletoconsiderbreastcancerasasingledisease.Subtypesc
