Arbeitsgemeinschaft Gynäkologische Onkologie Recommendations for the Diagnosis and Treatment of Patients with Early Breast Cancer: Update 2023

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Abstract

Background

Each year the interdisciplinary Arbeitsgemeinschaft Gynäkologische Onkologie (AGO), German Gynecological Oncology Group Breast Committee on Diagnosis and Treatment of Breast Cancer provides updated state-of-the-art recommendations for early and metastatic breast cancer.

Summary

The updated evidence-based treatment recommendation for early and metastatic breast cancer has been released in March 2023.

Key Messages

This paper concisely captures the updated recommendations for early breast cancer chapter by chapter.

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Most cited references 106

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Trastuzumab Emtansine for Residual Invasive HER2-Positive Breast Cancer

Gunter von Minckwitz, Chiun-Sheng Huang, Max S Mano … (2018)

Patients who have residual invasive breast cancer after receiving neoadjuvant chemotherapy plus human epidermal growth factor receptor 2 (HER2)-targeted therapy have a worse prognosis than those who have no residual cancer. Trastuzumab emtansine (T-DM1), an antibody-drug conjugate of trastuzumab and the cytotoxic agent emtansine (DM1), a maytansine derivative and microtubule inhibitor, provides benefit in patients with metastatic breast cancer that was previously treated with chemotherapy plus HER2-targeted therapy.

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Trastuzumab Deruxtecan in Previously Treated HER2-Low Advanced Breast Cancer

Shanu Modi, William Jacot, Toshinari Yamashita … (2022)

Among breast cancers without human epidermal growth factor receptor 2 (HER2) amplification, overexpression, or both, a large proportion express low levels of HER2 that may be targetable. Currently available HER2-directed therapies have been ineffective in patients with these "HER2-low" cancers.

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Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials

Michael Gnant, Early Breast Cancer Trialists' Collaborative Group (EBCTCG) (2011)

Summary Background As trials of 5 years of tamoxifen in early breast cancer mature, the relevance of hormone receptor measurements (and other patient characteristics) to long-term outcome can be assessed increasingly reliably. We report updated meta-analyses of the trials of 5 years of adjuvant tamoxifen. Methods We undertook a collaborative meta-analysis of individual patient data from 20 trials (n=21 457) in early breast cancer of about 5 years of tamoxifen versus no adjuvant tamoxifen, with about 80% compliance. Recurrence and death rate ratios (RRs) were from log-rank analyses by allocated treatment. Findings In oestrogen receptor (ER)-positive disease (n=10 645), allocation to about 5 years of tamoxifen substantially reduced recurrence rates throughout the first 10 years (RR 0·53 [SE 0·03] during years 0–4 and RR 0·68 [0·06] during years 5–9 [both 2p<0·00001]; but RR 0·97 [0·10] during years 10–14, suggesting no further gain or loss after year 10). Even in marginally ER-positive disease (10–19 fmol/mg cytosol protein) the recurrence reduction was substantial (RR 0·67 [0·08]). In ER-positive disease, the RR was approximately independent of progesterone receptor status (or level), age, nodal status, or use of chemotherapy. Breast cancer mortality was reduced by about a third throughout the first 15 years (RR 0·71 [0·05] during years 0–4, 0·66 [0·05] during years 5–9, and 0·68 [0·08] during years 10–14; p<0·0001 for extra mortality reduction during each separate time period). Overall non-breast-cancer mortality was little affected, despite small absolute increases in thromboembolic and uterine cancer mortality (both only in women older than 55 years), so all-cause mortality was substantially reduced. In ER-negative disease, tamoxifen had little or no effect on breast cancer recurrence or mortality. Interpretation 5 years of adjuvant tamoxifen safely reduces 15-year risks of breast cancer recurrence and death. ER status was the only recorded factor importantly predictive of the proportional reductions. Hence, the absolute risk reductions produced by tamoxifen depend on the absolute breast cancer risks (after any chemotherapy) without tamoxifen. Funding Cancer Research UK, British Heart Foundation, and Medical Research Council.

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Author and article information

Journal

Journal ID (nlm-ta): Breast Care (Basel)

Journal ID (iso-abbrev): Breast Care (Basel)

Journal ID (hwp): BRC

Journal ID (publisher-id): BRC

Title: Breast Care

Publisher: S. Karger AG (Basel, Switzerland )

ISSN (Print): 1661-3791

ISSN (Electronic): 1661-3805

Publication date (Electronic): 16 June 2023

Publication date (Print): August 2023

Volume: 18

Issue: 4

Pages: 289-305

Affiliations

[a ]Klinik für Frauenheilkunde und Geburtshilfe, Medizinische Hochschule Hannover, Hannover, Germany

[b ]Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany

[c ]Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Offenbach GmbH, Offenbach, Germany

[d ]Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Würzburg, Würzburg, Germany

[e ]Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Kiel, Germany

[f ]Frauenklinik, Klinikum Landshut gemeinnützige GmbH, Landshut, Germany

[g ]Klinik für Gynäkologie und Brustzentrum des Universitätsklinikums der Charite, Berlin, Germany

[h ]Klinik für Strahlentherapie und Radioonkologie Düsseldorf, Universitätsklinikum Düsseldorf, Düsseldorf, Germany

[i ]Klinik für Gynäkologie und Geburtshilfe, Städtisches Klinikum Lüneburg, Lüneburg, Germany

[j ]Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Augsburg, Augsburg, Germany

[k ]Institut für diagnostische und Interventionelle Radiologie, Klinikum der Technischen Universität München, Rechts der Isar, Munich, Germany

[l ]Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Erlangen, Erlangen, Germany

[m ]Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Düsseldorf, Düsseldorf, Germany

[n ]Klinik für Frauenheilkunde und Geburtshilfe, Helios Klinikum Krefeld GmbH, Krefeld, Germany

[o ]Universitätsfrauenklinik und Poliklinik am Klinikum Südstadt, Rostock, Germany

[p ]Brustzentrum, Evang. Krankenhaus Bethesda, Mönchengladbach, Germany

[q ]Brustzentrum, Klinik für Gynäkologie und Geburtshilfe, Klinikum der Ludwig-Maximilians-Universität, Munich, Germany

[r ]Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany

[s ]Brustzentrum Heidelberg, Klinik St. Elisabeth und Klinik für Frauenheilkunde und Geburtshilfe, Sektion Senologie, Universitäts-Klinikum Heidelberg, Heidelberg, Germany

[t ]Brustzentrum, Kantonspital St. Gallen, St. Gallen, Switzerland

[u ]Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Essen, Phaon GmbH, Wiesbaden, Germany

[v ]Institut für Pathologie, Medizinische Hochschule Hannover, Hannover, Germany

[w ]Klinik für Strahlentherapie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany

[x ]Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Esslingen, Esslingen, Germany

[y ]Klinik für Senologie, Evangelische Kliniken Essen Mitte, Essen, Germany

[z ]German Breast Group Forschungs GmbH, Frankfurt, Germany

[A ]Immanuel Klinik Märkische Schweiz (Buckow) & Immanuel Klinik Rüdersdorf/Medizinische Hochschule Brandenburg Theodor Fontane (Rüdersdorf), Rüdersdorf, Germany

[B ]Kooperatives Brustzentrum Paderborn, Klinik für Gynäkologie und Geburtshilfe, Frauenklinik St. Louise, Paderborn und St. Josefs-Krankenhaus, Salzkotten, St. Vincenz-Krankenhaus GmbH, Paderborn, Germany

[C ]Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Germany

[D ]Klinik für Gynäkologie und Geburtshilfe, Klinikum Bayreuth, Germany

[E ]Zentrum Familiärer Brust- und Eierstockkrebs, Centrum für Integrierte Onkologie (CIO), Universitätsklinikum Köln, Cologne, Germany

[F ]Klinik und Poliklinik für Geburtshilfe und Frauengesundheit der Johannes-Gutenberg-Universität Mainz, Mainz, Germany

[G ]Nationales Centrum für Tumorerkrankungen, Universitätsklinikum und Deutsches Krebsforschungszentrum, Heidelberg, Germany

[H ]Klinik für Gynäkologie und Geburtshilfe, Diakonissen Krankenhaus Speyer, Speyer, Germany

[I ]Sektion Gynäkopathologie, Pathologisches Institut, Universitätsklinikum Heidelberg, Heidelberg, Germany

[J ]Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Frankfurt, Germany

[K ]Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg, Germany

[L ]Klinik für Gynäkologie und Geburtsmedizin, Universitätsklinikum Aachen, Aachen, Germany

[M ]Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Germany

[N ]Klinik für Gynäkologie und Geburtshilfe, Helios Klinikum Berlin-Buch, Berlin, Germany

[O ]Department of Gynecology, University Medical Center Zurich, University of Zurich, Zurich, Switzerland

[P ]Klinik für Gynäkologie und Gynäkologische Onkologie, Agaplesion Markus Krankenhaus, Frankfurt, Germany

Author notes

Correspondence to: Tjoung-Won Park-Simon, park-simon.tjoung-won@ 123456mh-hannover.de

Article

Publisher ID: 531578

DOI: 10.1159/000531578

PMC ID: 10601667

PubMed ID: 37900552

SO-VID: 69fb3d18-4d20-4075-ab67-8a4e8134d930

License:

This article is licensed under the Creative Commons Attribution 4.0 International License (CC BY) ( http://www.karger.com/Services/OpenAccessLicense). Usage, derivative works and distribution are permitted provided that proper credit is given to the author and the original publisher.

History

Date received : 8 June 2023

Date accepted : 12 June 2023

Date: 2023

Page count

References: 112, Pages: 17

Funding

The authors received no financial support/funding for this review article.

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Abstract

Background

Summary

Key Messages

Related collections

Karger: Oncology

Most cited references 106

Trastuzumab Emtansine for Residual Invasive HER2-Positive Breast Cancer

Trastuzumab Deruxtecan in Previously Treated HER2-Low Advanced Breast Cancer

Relevance of breast cancer hormone receptors and other factors to the efficacy of adjuvant tamoxifen: patient-level meta-analysis of randomised trials

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