Hans-Jörg Senn

Tumor- und Brustzentrum ZeTuP Silberturm · Department of Medical Oncology

The 17th St Gallen International Breast Cancer Consensus Conference in 2021 was held virtually, owing to the global COVID19 pandemic. More than 3,300 participants took part in this important bi-annual critical review of the "state of the art" in the multidisciplinary care of early-stage breast cancer. Seventy-four expert panelists (see Appendix) fr...

In the original article, the disclosure was incomplete. This has now been updated to add the statement for J. Baselga: JBa is on the Board of Directors for Varian Medical Systems, Bristol-Myers Squibb, and is a past board member of Grail. He has performed consulting and/or advisory work for Roche, Lilly, and Novartis. Also, originally the disclosur...

The 14(th) St. Gallen International Breast Cancer Conference (2015) reviewed substantial new evidence on locoregional and systemic therapies for early breast cancer. Further experience has supported the adequacy of tumour margins defined as 'no ink on invasive tumour or DCIS' and the safety of omitting axillary dissection in specific cohorts. Radio...

Background: Accumulating evidence supports an effect of aspirin in reducing overall cancer incidence and mortality in the general population. We reviewed current data and assessed the benefits and harms of prophylactic use of aspirin in the general population. Methods: The effect of aspirin for site-specific cancer incidence and mortality, cardi...

Breast cancer has become curable for the majority of women in Western Europe and North America. Advances have been made in imaging diagnostics as well as the implementation of nationwide screening programmes. Nowadays, we talk about prevention as well as treatment. Pathology has moved from pure morphology (tumour type, grade and stage) to biologica...

The 13th St Gallen International Breast Cancer Conference (2013) Expert Panel reviewed and endorsed substantial new evidence on aspects of the local and regional therapies for early breast cancer, supporting less extensive surgery to the axilla and shorter durations of radiation therapy. It refined its earlier approach to the classification and man...

Background Aromatase inhibitors effectively prevent breast cancer recurrence and development of new contralateral tumours in postmenopausal women. We assessed the efficacy and safety of the aromatase inhibitor anastrozole for prevention of breast cancer in postmenopausal women who are at high risk of the disease. Methods Between Feb 2, 2003, and J...

Ziel adjuvanter chemotherapeutischer Behandlungsmaßnahmen ist die Eradikation verborgener lymphogener und insbesondere hämatogener Mikrometastasen, die sich nach der Entfernung des Primärtumors und der axillären Lymphknoten noch im Organismus befinden können. Nachbeobachtungen von Patientinnen, die vor 20 Jahren adjuvant medikamentös behandelt word...

The 12th St Gallen International Breast Cancer Conference (2011) Expert Panel adopted a new approach to the classification of patients for therapeutic purposes based on the recognition of intrinsic biological subtypes within the breast cancer spectrum. For practical purposes, these subtypes may be approximated using clinicopathological rather than...

With the continuing increase of median life expectancy of important segments of the world's population, cancer incidence, as well as cancer related morbidity and mortality, are constantly increasing, especially for developing countries and for breast and prostate cancer, the predominant gender-associated cancer types. In addition to continuing, wit...

The 11th St. Gallen consensus meeting on the primary treatment of early breast cancer put a special emphasis on a tailored approach for patient subgroups, and by the selection of targetted treatments according to tumour biology. Sentinel node procedure was considered as the standard in invasive breast cancer with no clinical evidence of lymph node...

To provide guidance for clinicians about the diagnosis, staging and treatment of breast cancer occurring during an otherwise uncomplicated pregnancy. An international expert Panel convened to address a series of questions identified by a literature review and personal experience. Issues relating to the diagnosis and management of breast cancer afte...

Angiogenesis and lymphangiogenesis are considered to play key roles in tumour growth, progression and metastasis. However, targeting tumour angiogenesis in clinical trials showed only modest efficacy. We therefore scrutinised the concept of tumour angiogenesis and lymphangiogenesis by analysing the expression of crucial markers involved in these pr...

The 11th St Gallen (Switzerland) expert consensus meeting on the primary treatment of early breast cancer in March 2009 maintained an emphasis on targeting adjuvant systemic therapies according to subgroups defined by predictive markers. Any positive level of estrogen receptor (ER) expression is considered sufficient to justify the use of endocrine...

Evidence clearly shows a chemopreventive effect for aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) on colorectal cancer and probably other cancer types; however, data on the risk-benefit profile for cancer prevention are insufficient and no definitive recommendations can be made. Aspirin has emerged as the most likely NSAID for us...

BACKGROUND: Angiogenesis and lymphangiogenesis are considered to play key roles in tumour growth, progression and metastasis. However, targeting tumour angiogenesis in clinical trials showed only modest efficacy. We therefore scrutinised the concept of tumour angiogenesis and lymphangiogenesis by analysing the expression of crucial markers involved...

The NSABP Study of Tamoxifen and Raloxifene (STAR), launched in 1999, compared tamoxifen with raloxifene in a population of healthy postmenopausal women at increased risk for breast cancer to determine the relative effects on the risk of invasive breast cancer. To be eligible for participation, a woman had to be healthy with at least a 5-year predi...

Recently reported results of a phase 2 study combining the aromatase inactivator exemestane with the cyclooxygenase-2 (COX-2) inhibitor celecoxib for the treatment of breast cancer showed that patients receiving the combined treatment had response rates and clinical benefit rates that were similar to those of the group receiving exemestane only (1)...

Pancreatic neuroendocrine tumors (NETs) consist of a wide group of neoplasms with diVerent biologic and clinical characteristics. Surgery is believed to be the only curative approach but diagnosis is often delayed due to slow growth and diYcult interpretation of symptoms due to tumorrelated hormone production. In addition to surgery, biological the...

The 10th St Gallen (Switzerland) expert consensus meeting in March 2007 refined and extended a target-oriented approach to adjuvant systemic therapy of early breast cancer. Target definition is inextricably intertwined with the availability of target-specific therapeutic agents. Since 2005, the presence of HER2 on the cell surface has been used as...

Treatment guidelines are useful tools that enable physicians to integrate the latest clinical research into their practices. The large volume of rapidly evolving clinical data in breast cancer has been summarised and incorporated into treatment recommendations by well-known and reliable institutions, including the National Comprehensive Cancer Netw...

St Gallen Expert Consensus meetings update evidence on treatment of early breast cancer every 2 years and interpret its significance for treatment of individual patients. Such interpretation is controversial. Clinical decisions cannot, however, be postponed, and the harms of failing to tailor treatment must be balanced against those of overinterpre...

To evaluate and validate mRNA expression markers capable of identifying patients with ErbB2-positive breast cancer associated with distant metastasis and reduced survival. Expression of 60 genes involved in breast cancer biology was assessed by quantitative real-time PCR (qrt-PCR) in 317 primary breast cancer patients and correlated with clinical o...

Well into the second half of the 20th century, physicians ‐ and especially surgeons ‐ were used to treat their patients ‘optimally’ on the basis of their own accumulated professional experience, and as they got older and even more experienced, with an ever increasing conviction that what they decided for their patients was ‘the right way’ to procee...

Multi-target stereotactic core-needle breast biopsy (MSBB) with large core needles is a modern and effective method to quickly determine the histologic nature of non-palpable breast lesions in an easy ambulatory setting. The number of patients with mammographically detectable, suspicious breast lesions is constantly increasing due to enhanced breas...

Circulating endothelial cells (CECs) as well as bone-marrow-derived endothelial precursor cells (EPC) play an important role in neovascularisation and tumour growth. To study the impact of neoadjuvant chemotherapy on the amounts of CEC and their precursor cells, mature CEC and their progenitors were quantified by flow cytometry in peripheral blood...

High serum concentrations of insulin-like growth factor-1 (IGF-1) are associated with an increased risk of breast, prostate, colorectal, and lung cancer whereas IGF binding protein-3 (IGFBP-3) seems to exert a protective effect. Therefore, patients may benefit from low IGF-1 levels and high IGFBP-3 levels. This study evaluated whether adjuvant anth...

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Background in early breast cancer, variations in local treatment that substantially affect the risk of locoregional recurrence could also affect long-term breast cancer mortality. To examine this relationship, collaborative meta-analyses were undertaken, based on individual patient data, of the relevant randomised trials that began by 1995. Methods...

Angiogenesis is a fundamental process in tumour growth and metastatic dissemination. Possible surrogate markers for tumour angiogenesis are the amounts of circulating endothelial cells (CEC) in peripheral blood and the plasma concentration of vascular endothelial growth factor (VEGF). We tested the suitability of real-time PCR for CD146, an endothe...

The ninth St Gallen (Switzerland) expert consensus meeting in January 2005 made a fundamental change in the algorithm for selection of adjuvant systemic therapy for early breast cancer. Rather than the earlier approach commencing with risk assessment, the Panel affirmed that the first consideration was endocrine responsiveness. Three categories wer...

More than 4,000 participants attended the congress and the consensus conference 2005, an increase of more than 1,000 participants. The conference had 2 highlights. (1) The presentation of the first results of the study BIG 1-98 -- letrozole as adjuvant, endocrine therapy in postmenopausal women with hormone-sensitive breast cancer -- showed a relat...

Background Quinquennial overviews (1985-2000) of the randomised trials in early breast cancer have assessed the 5-year and 10-year effects of various systemic adjuvant therapies on breast cancer recurrence and survival. Here, we report the 10-year and 15-year effects. Methods Collaborative meta-analyses were undertaken of 194 unconfounded randomise...

Based on results of trials emerged during the last 2 years and on data presented at the 8th International Conference on Primary Therapy of Early Breast Cancer held in 2003 in St. Gallen, a summary of current knowledge and controversies in the management of breast cancer is given. The following topics are covered: screening, biology, surgery, radiat...

Increasing numbers of older women are affected by early breast cancer, because of prolonged life expectancy and the increasing incidence of breast cancer with age. The role of adjuvant therapy for this population is still a matter of debate. We reviewed the long-term outcome of a mature trial comparing endocrine treatment versus no adjuvant therapy...

This final paper of the proceedings of the recent Eighth St. Gallen Conference 2003 on the Primary Therapy of Early Breast Cancer comments on the Consensus Paper put forth by the international expert panel and emphasizes new information, that has emerged during the 2 years since the seventh such meeting in 2001. More than 3200 breast cancer special...

This account of the highlights of the eighth St Gallen (Switzerland) meeting in 2003 emphasizes new information that has emerged during the 2 years since the seventh meeting in 2001. This article should be read in conjunction with the report of that earlier meeting. Recommendations for patient care are so critically dependent on assessment of endoc...

To investigate the process of metastasis, primary clinical data and disease events such as metastases, local recurrence and survival (median follow-up 9.4 years) from the Munich Cancer Registry from 1978 to 1996 were analysed. Since metastases, even from small tumours, may be initiated before the diagnosis of the primary tumour, the growth of the p...

Primary systemic therapy (PST) represents the standard of care in patients with locally advanced breast cancer. In addition, there is increasing information on PST in operable breast disease that supports the use of PST in routine practice. However, current regimens and techniques vary. To address this concern, a group of representatives from breas...

The insulin-like growth factor (IGF) system performs multiple functions in normal tissue. IGFs are involved in normal mammary gland development, but have also been implicated in the pathogenesis of breast cancer. Epidemiological studies found an association between elevated serum levels of IGF-I and an increased risk for breast cancer. IGF-I is the...

Background: The role of adjuvant chemotherapy in postmenopausal patients with lymph node-negative breast cancer is controversial. After demonstrating the efficacy of chemotherapy combined with tamoxifen for postmenopausal patients with lymph node-positive disease, the International Breast Cancer Study Group launched a randomized trial (Trial IX) to...

Interest in insulin-like growth factors (IGFs) and their effect on carcinogenesis has increased recently because high serum concentrations of IGF1 are associated with an increased risk of breast, prostate, colorectal, and lung cancers. Physiologically, IGF1 is the major mediator of the effects of the growth hormone; it thus has a strong influence o...

Germ-line alterations in BRCA1 and BRCA2 genes account for 30-50% of all forms of familial breast and ovarian cancer syndromes. Specific mutations in specific populations and ethnic groups have been identified in BRCA1 and BRCA2. However, it is not known whether such specific mutations prevail in the Swiss population. We started to screen patients...

To identify patient populations at high risk for bone metastases at any time after diagnosis of operable breast cancer, because these patients are potential beneficiaries of treatment with bisphosphonates. We evaluated data from 6,792 patients who were randomized in International Breast Cancer Study Group clinical trials between 1978 and 1993. Medi...

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Information on the tolerability and efficacy of adjuvant chemoendocrine therapy for older women is limited. We studied these issues using the data collected as part of the International Breast Cancer Study Group Trial VII. Postmenopausal women with operable, node-positive breast cancer were randomized to receive either tamoxifen alone for 5 years (...

This phase III study compared docetaxel with mitomycin plus vinblastine (MV) in patients with metastatic breast cancer (MBC) progressing despite previous anthracycline-containing chemotherapy. Patients (n=392) were randomized to receive either docetaxel 100 mg/m2 intravenously (i.v.) every 3 weeks (n=203) or mitomycin 12 mg/m2 i.v. every 6 weeks pl...

The effects and interaction of endocrine and cytotoxic adjuvant treatment on measures of cellular immunity were assessed in 41 stage I–II breast cancer patients from International Breast Cancer Study Group trials. Counts of lymphocytes and lymphocyte subsets [(T, T4, T8, B, natural killer (NK) and activated T (AT) cells] were assessed by flow cytom...

The aim of this double-blind, randomized study was to compare the effects of two pamidronate dosages, given as repeated infusions in patients with advanced malignant osteolytic bone disease and bone pain. Seventy patients were randomly assigned to receive pamidronate 60 mg or 90 mg i.v. every 3 weeks for a maximum of six cycles. Pain parameters, an...

Seventy cancer patients with malignant osteolytic bone disease received pamidronate every three weeks for a maximum of six cycles. Bone resorption parameters, urinary calcium excretion, and pain parameters were assessed at baseline and throughout the study. At baseline, 80–95 % of patients showed elevated urinary pyridinoline, deoxypyridinoline, Os...

Quality of life (QL) is used to assess treatments in clinical trials but may be influenced by other factors. We analysed the impact of biomedical, sociodemographic and cultural factors on baseline QL indicators in two International Breast Cancer Study Group trials. Patients with stage II breast cancer were randomized within 6 weeks of primary surge...

Quality of life (QL) is used to assess treatments in clinical trials but may be influenced by other factors. We analysed the impact of biomedical, sociodemographic and cultural factors on baseline QL indicators in two International Breast Cancer Study Group trials. Patients with stage II breast cancer were randomized within 6 weeks of primary surge...

In dieser kurzen Übersicht sollen zuerst die Grundlagen und das Rationale der adjuvanten systemischen Chemotherapie erklärt und dies anschließend an drei Beispielen illustriert werden, nämlich: Mammakarzinom, kolorektale und nichtkleinzellige Bronchus-Karzinome. Nicht behandelt werden endokrine Zusatztherapie, Vitamine, Differenzierungs-Induktoren...

Adjuvant chemotherapy-induced amenorrhoea has been shown to be associated with reduced relapses and improved survival for premenopausal breast cancer patients. Amenorrhoea was, therefore, studied to define features of chemotherapy (i.e. duration and timing) and disease-related factors which are associated with its treatment effects. We reviewed dat...

Providing effective care for patients with early-stage breast cancer and designing appropriate recommendations for women at high risk of developing the disease are important public health goals. More than ever, progress requires integrated understanding based on the continuous interaction among several scientific and clinical disciplines. In Februa...

Biology New treatment selection criteria will arise from molecular biology parameters of growth and treatment response, most probably coupled with the increasing use of initial chemotherapy and repeated minimally invasive surgery. Prevention Secondary and hopefully also primary prevention of breast cancer will become more and more successful in th...

Breast cancer metastases appearing soon after adjuvant chemotherapy (within 12 months of its completion) are usually resistant to retreatment with the same cytotoxic agents, while relapses occurring later (beyond 12 months) regress when rechallenged with the same agents, showing similar response rates observed in non-pretreated patients with advanc...

Clinical trials in breast cancer have demonstrated convincingly that agents with systemic activity in advanced disease can improve survival when these agents are given adjuvantly to patients in early stages of the disease (Early Breast Cancer Trialist’s Collaborative Group 1992). Results from controlled adjuvant trials do appear to translate into b...

Breast cancer metastases appearing soon after adjuvant chemotherapy (within 12 months of its completion) are usually resistant to retreatment with the same cytotoxic agents, while relapses occurring later (beyond 12 months) regress when rechallenged with the same agents, showing similar response rates observed in non-pretreated patients with advanc...

The International Breast Cancer Study Group (IBCSG) has developed and approach for assessing the impact of adjuvant therapy on quality of life (QL) within the framework of international, multilingual clinical trials. The major steps are summarized. Conceptual, methodological and practical issues are discussed with reference to results of two trials...

It has been postulated that breast cancer surgery performed during the follicular phase of the menstrual cycle is associated with poorer outcome. We tested this hypothesis by evaluating disease-free survival (DFS) for 1033 premenopausal patients who received definitive surgery either during the follicular phase (n = 358) or the luteal phase (n = 67...

To compare two adjuvant combination chemotherapies, cyclophosphamide, methotrexate, and fluorouracil (CMF) and chlorambucil, methotrexate, and fluorouracil (LMF), for patients who had undergone potentially curative surgery for unilateral breast cancer, in terms of relapse, survival, and toxicity. Selection criteria was as follows: stage pT1-3a, N+...

The question of whether initial prognostic factors in small-cell lung cancer patients have a predictive value for patients' quality of life (QL) during chemotherapy is addressed in the context of a randomised clinical trial comparing early and late alternating chemotherapy (SAKK protocol 15/84). The relative impact of initial tumour stage and perfo...

Background Among women with early breast cancer, the effects of ovarian ablation on recurrence and death have been assessed by several randomised trials that now have long follow-up. In this report, the Early Breast Cancer Trialists' Collaborative Group present their third 5-yearly systematic overview (meta-analysis), now with 15 years' follow-up....