AGO Recommendations for the Diagnosis and Treatment of Patients with Early Breast Cancer: Update 2021

Ditsch, Nina; Kolberg‐Liedtke, Cornelia; Friedrich, Michael; Jackisch, Christian; Albert, Ute‐Susann; Banys‐Paluchowski, Maggie; Bauerfeind, Ingo; Blohmer, Jens-Uwe; Budach, Wilfried; Dall, P.; Fallenberg, Eva Maria; Fasching, Peter A.; Fehm, Tanja; Gerber, Bernd; Gluz, Oleg; Harbeck, Nadia; Heil, Jörg; Huober, Jens; Kreipe, Hans-Heinrich; Krug, David; Kühn, Thorsten; Kümmel, Sherko; Loibl, Sibylle; Lüftner, Diana; Lux, Michael P.; Maass, Nicolaì; Mundhenke, Christoph; Nitz, Ulrike; Park‐Simon, Tjoung‐Won; Reimer, Toralf; Rhiem, Kerstin; Rody, Achim; Schmidt, Marcus; Schneeweiß, Andreas; Schütz, Florian; Sinn, Hans‐Peter; Solbach, Christine; Solomayer, Erich‐Franz; Stickeler, Elmar; Thomssen, Christoph; Untch, Michael; Witzel, Isabell; Wöckel, Achim; Müller, Volkmar; Janni, Wolfgang; Thill, Marc

doi:10.1159/000516419

Cited by 54 publications

(81 citation statements)

References 82 publications

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“…For the first time, the current update on surgical axillary management is going into more detail about the significance of isolated tumour cells and micro-metastasis after neoadjuvant chemotherapy (NACT) and the clinical consequences of low volume residual disease diagnosed based on SLNE und TAD. This article provides an overview of this yearʼs AGO recommendations ( Tables 1 to 3 ) on surgical management of the axilla in primary surgery and in relation to neoadjuvant chemotherapy 1 .…”

Section: Introductionmentioning

confidence: 99%

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AGO Recommendations for the Surgical Therapy of the Axilla After Neoadjuvant Chemotherapy: 2021 Update

Friedrich

Kühn

Janni

et al. 2021

Geburtshilfe Frauenheilkd

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For many decades, the standard procedure to treat breast cancer included complete dissection of the axillary lymph nodes. The aim was to determine histological node status, which was then used as the basis for adjuvant therapy, and to ensure locoregional tumour control. In addition to the debate on how to optimise the therapeutic strategies of systemic treatment and radiotherapy, the current discussion focuses on improving surgical procedures to treat breast cancer. As neoadjuvant chemotherapy is becoming increasingly important, the surgical procedures used to treat breast cancer, whether they are breast surgery or axillary dissection, are changing. Based on the currently available data, carrying out SLNE prior to neoadjuvant chemotherapy is not recommended. In contrast, surgical axillary management after neoadjuvant chemotherapy is considered the procedure of choice for axillary staging and can range from SLNE to TAD and ALND. To reduce the rate of false negatives during surgical staging of the axilla in pN+CNB stage before NACT and ycN0 after NACT, targeted axillary dissection (TAD), the removal of > 2 SLNs (SLNE, no untargeted axillary sampling), immunohistochemistry to detect isolated tumour cells and micro-metastases, and marking positive lymph nodes before NACT should be the standard approach. This most recent update on surgical axillary management describes the significance of isolated tumour cells and micro-metastasis after neoadjuvant chemotherapy and the clinical consequences of low volume residual disease diagnosed using SLNE and TAD and provides an overview of this yearʼs AGO recommendations for surgical management of the axilla during primary surgery and in relation to neoadjuvant chemotherapy.

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Section: Introductionmentioning

confidence: 99%

“…der diesjährigen AGO-Empfehlungen ( Tab. 1 bis 3 ) zum operativen Management der Axilla im Rahmen der Primäroperation und im Zusammenhang mit der neoadjuvanten Chemotherapie 1 .…”

Section: Introductionunclassified

AGO Recommendations for the Surgical Therapy of the Axilla After Neoadjuvant Chemotherapy: 2021 Update

Friedrich

Kühn

Janni

et al. 2021

Geburtshilfe Frauenheilkd

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“…Later, the ATLAS and aTTom trials demonstrated that an extension in treatment from five to up to ten years leads to a further survival benefit [ 20 , 21 ]; such a treatment duration then became an option, especially for premenopausal patients with a high risk of recurrence [ 10 , 22 ]. In these women, additional ovarian function suppression is also recommended [ 10 , 22 ]. The SOFT and TEXT trials showed improved disease-free survival and overall survival, adding OFS to a treatment with tamoxifen alone [ 23 , 24 , 25 ].…”

Section: History and The State Of The Art Of Endocrine Treatmentmentioning

confidence: 99%

“…According to current results, the optimal therapy duration of AIs seems to be at least five years, but due to an ongoing risk of recurrence after the first five years in patients with high-risk BC, a prolongation for up to 10 years in terms of an extended ET seems to further improve DFS [ 10 , 29 , 30 ]. Nevertheless, statements regarding the exact duration of the extended treatment are partially contradictory, since there are studies that have shown a non-inferiority of seven to eight years of ET compared to 10 years [ 31 ] or even no significant difference at all when comparing five versus ten years of AI therapy [ 32 ].…”

Section: History and The State Of The Art Of Endocrine Treatmentmentioning

confidence: 99%

“…While in a metastatic treatment setting the primary objective is to improve progression-free survival (PFS) and overall survival (OS), while maintaining quality of life (QoL) at the same time, the goal of adjuvant ET is to reduce the disease recurrence and mortality rates of hormone-receptor-positive early breast cancer (eBC) patients [ 2 , 8 ] with an acceptable risk–benefit ratio. In premenopausal women with eBC and a low risk of disease recurrence, tamoxifen is the preferred adjuvant ET [ 2 , 9 ]; in those with a high risk, the combination of tamoxifen or an AI with ovarian function suppression (OFS) is recommended [ 10 ]; and in postmenopausal eBC patients, therapy with an AI is the treatment of choice [ 10 ], since it shows superior results regarding disease-free survival (DFS) [ 8 , 11 , 12 , 13 , 14 , 15 ] and, in some trials, OS as well [ 8 , 13 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

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Endocrine Treatment for Breast Cancer Patients Revisited—History, Standard of Care, and Possibilities of Improvement

Nabieva

Fasching

2021

Cancers

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Purpose of review: Due to the findings of current studies and the approval of novel substances for the therapy of hormone-receptor-positive breast cancer patients, the established standards of endocrine treatment are changing. The purpose of this review is to give an overview of the history of endocrine treatment, to clarify its role in the present standard of care, and to discuss the possibilities of improvement. Recent findings: Tamoxifen, aromatase inhibitors, and fulvestrant are the main drugs that have been used for decades in the therapy of hormone-receptor-positive breast cancer patients. However, since a relevant number of women suffer at some point from disease recurrence or progression, several novel substances are being investigated to overcome resistance mechanisms by interfering with certain signaling pathways, such as the PI3K/AKT/mTOR or the CDK4/6 pathways. mTOR and CDK4/6 inhibitors were the first drugs approved for this purpose and many more are in development. Summary: Endocrine treatment is one of the best tolerable cancer therapies available. Continuous investigation serves to improve patients’ outcomes and modernize the current standard of care. Considering the resistance mechanisms and substances analyzed against these, endocrine treatment of hormone-receptor-positive breast cancer is on the brink of a new era.

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The heparan sulphate proteoglycan Syndecan‐1 (CD138) regulates tumour progression in a 3D model of ductal carcinoma in situ of the breast

et al. 2022

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Ductal carcinoma in situ (DCIS) is a form of breast cancer that is restricted to the lactiferous ducts and has not yet invaded the surrounding breast tissue.Dysregulation of the transmembrane heparan sulphate proteoglycan Syndecan-1 (Sdc-1) plays a role in tumour progression of invasive breast cancer (IBC). In DCIS, Sdc-1, c-Met and E-cadherin are part of a proangiogenic expression signature. In this study, we employed a siRNA knockdown approach in the DCIS model cell line MCF10A DCIS.com to investigate a potential connection between Sdc-1 and epithelial mesenchymal transition (EMT), proteolysis and the Rho kinase pathway. Analysis of gene expression data of the TNMplot.com database revealed that Sdc-1 expression was higher in primary breast tumours compared to metastases. The impact of Sdc-1-depletion on the cellular phenotype was investigated in a Matrigel-based three-dimensional cell culture model. Sdc-1 depletion resulted in the formation of larger spheroids and the formation of invasive protrusions. Application of matrix metalloproteinase (MMP) and Rho kinase inhibitors could block the Sdc-1-induced phenotype. qPCR analysis of Sdc-1-depleted cells in twodimensional culture revealed upregulated expression of the EMT-markers CDH1, FN-1, CLDN1, the proteolysis markers MMP3, and MMP9, and HPSE, while MMP2, VIM and ROCK-2 were downregulated. Immunocytochemistry confirmed upregulation of MMP9 and fibronectin, the latter being particular prominent after ROCK inhibition. STRING analysis confirmed an interaction

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AGO Recommendations for the Diagnosis and Treatment of Patients with Early Breast Cancer: Update 2021

Cited by 54 publications

References 82 publications

AGO Recommendations for the Surgical Therapy of the Axilla After Neoadjuvant Chemotherapy: 2021 Update

AGO Recommendations for the Surgical Therapy of the Axilla After Neoadjuvant Chemotherapy: 2021 Update

Endocrine Treatment for Breast Cancer Patients Revisited—History, Standard of Care, and Possibilities of Improvement

The heparan sulphate proteoglycan Syndecan‐1 (CD138) regulates tumour progression in a 3D model of ductal carcinoma in situ of the breast

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