Highlights of the 16th St Gallen International Breast Cancer Conference, Vienna, Austria, 20–23 March 2019: personalised treatments for patients with early breast cancer

Abstract

The 16th St Gallen International Breast Cancer Conference took place in Vienna for the third time, from 20–23 March 2019. More than 3000 people from all over the world were invited to take part in this important bi-annual critical review of the ‘state of the art’ in the primary care of breast cancer (BC), independent of political and industrial pressure, with the aim to integrate the most recent research data and most important developments in BC therapies since St Gallen International Breast Cancer Conference 2017, with the ultimate goal of drawing up a consensus for the current optimal treatment and prevention of BC. This year, the St Gallen Breast Cancer Award was won by Monica Morrow (Memorial Sloan Kettering Cancer Center, USA) for her extraordinary contribution in research and practise development in the treatment of BC. She opened the session with the lecture ‘Will surgery be a part of BC treatment in the future?’ Improved systemic therapy has decreased BC mortality and increased pathologic complete response (pCR) rates after neoadjuvant chemotherapy (NACT). Improved imaging and increased screening uptake have led to detect smaller cancers. These factors have highlighted two possible scenarios to omit surgery: for patients with small low-grade ductal carcinoma in situ (DCIS) and for those who have received NACT and had a clinical and radiological complete response. However, considering that 7%–20% of `low-risk’ DCIS patients have co-existing invasive cancer at diagnosis, that surgery has become progressively less morbid and less toxic than some systemic therapies with a lower cost-effectiveness ratio, and that identification of pathologic complete response (pCR) without surgery requires more intensive imaging follow-up (more biopsies, higher cost and more anxiety for the patient), surgery still appears to be an essential treatment for BC. The Umberto Veronesi Memorial Award went to Lesley Fallowfield (Brighton and Sussex Medical School, UK) for her important research and activity in the field of the development of patient outcome, of better communication skills and quality of life for women. In her lecture, she remarked on the importance of improving BC personalised treatments, especially through co-operation between scientists, always considering the whole woman and not just her breast disease. This award was given by Paolo Veronesi, after a moving introduction which culminated with the following words of Professor Umberto Veronesi: ‘It is not possible to take care of the people’s bodies without taking care of their mind. My duty, the duty of all doctors, is to listen and be part of the emotions of those we treat every day’.

Radiological Assessment of Response to Neoadjuvant Chemotherapy in Breast Cancer Females, Using Standard and Spectral Mammography

“…Currently, neoadjuvant chemotherapy (NACT) is widely used as rst of multidisciplinary management of breast cancer without distant metastases [16,17,18,19]. Besides reducing the tumour mass and thereby offering better conditions for local treatment (BCT -breast conserving therapy), NACT provides professionals with unique opportunities for in vivo chemotherapeutic evaluation of cancer cells' sensitivity and for the quest of new biomarkers of therapeutic response, and -in the event of poor response and progression of the disease -it offers a chance to alter the treatment scheme or refer a given patient for surgical treatment [20,21].…”

The Role of MicroRNA as Clinical Biomarkers for Breast Cancer Surgery and Treatment

“…The gold standard in classifying breast tumours into these intrinsic biological subtypes is determined using multigene signatures (such as PAM50 assay from NanoString Technologies, Seattle, Washington, USA). However, the routine immunohistochemical appraisal of the estrogen (ER), progesterone (PgR) and HER2 receptor, as well as proliferation indices (Ki-67) in locally accredited histopathology laboratories, are also utilised in practice [ 5 ].…”

Automated Quantification of sTIL Density with H&E-Based Digital Image Analysis Has Prognostic Potential in Triple-Negative Breast Cancers

“…Recently, stromal tumor-infiltrating lymphocytes (sTIL) have resurfaced as a strong prognostic biomarker for overall survival (OS) [ 7 , 8 , 9 , 10 ], and guidelines for manual assessment have been proposed [ 11 ] to standardize reporting, increase reproducibility, and improve clinical adoption [ 12 , 13 ]. Nevertheless, the manual assessment has innate limitations [ 14 ] that hinder clinical adoption.…”

“…It has a long history as a prognostic biomarker (more than 100 years) [ 19 ], but its clinical validity for early-stage TNBC was only recently well-established through level 1b evidence [ 20 , 21 , 22 ]. Incorporating sTILs into standard clinical practice is now endorsed by multiple international clinical standards since 2019 (St. Gallen Breast Cancer Expert Committee [ 12 ], World Health Organization (WHO) [ 23 ], and ESMO [ 24 ]). The guidelines to manually score sTIL status is proposed by the TIL-WG, and briefly, scored as the area of tumor-associated stroma occupied by TILs estimated as a percentage of total tumor-associated stromal area, where areas of necrosis, ductal and lobular carcinoma in situ (DCIS/LCIS), and normal breast tissue are excluded [ 25 ].…”