Guidelines for patient specific treatments in early breast cancer

The authors aimed to give specific breast cancer treatment guidelines determined by medical experts.

The St. Gallen International Breast Cancer Conference is held every two years. Leading experts in breast cancer research meet at this conference to determine the most up-to-date guidelines for treatment. The 2015 conference added to the recommendations for use of chemotherapy and hormone therapies in both low-risk and high-risk early breast cancers.

Tamoxifen (Nolvadex) is a treatment used in patients with hormone receptor positive (HR+, dependent on hormones such as estrogen for growth) breast cancers. In premenopausal patients with low-risk HR+ breast cancer, 5 years of tamoxifen is recommended. High-risk patients are those younger than 35 years old with cancer found in 4 or more lymph nodes. In high-risk patients, treatments that block the function of the ovaries (the organs where estrogen is produced), such as exemestane (Aromasin), were recommended, along with tamoxifen for 5–10 years.

In patients who have already gone through menopause, tamoxifen was recommended for 5–10 years. In patients who have 4 or more lymph nodes involved, an aromatase inhibitor, such as letrozole (Femara), is also recommended.

Chemotherapy is recommended for all types of breast cancer, except patients with very small HER2+ (dependent on HER2 for growth)/HR negative tumors that have not spread to the lymph nodes. For HER2+ tumors larger than 5 mm, chemotherapy plus trastuzumab (Herceptin, a treatment that blocks HER2) is recommended.

The chemotherapy paclitaxel (Taxol) should be considered in patients with smaller tumors, while anthracyclines, such as doxorubicin (Adriamycin) should be added in patients with larger tumors. Patients with triple-negative breast cancer (not dependent on HER2 or hormones for growth) are also recommended to undergo anthracycline and paclitaxel-based chemotherapy.

Chemotherapy is often used prior to surgery to shrink a tumor. The panel concluded that if the tumor shrinks, it is not necessary to surgically remove the entire area of the original tumor.

Standard therapy for patients with larger tumors includes surgical removal of the entire breast (mastectomy) and radiation therapy. It is recommended that for these patients radiation be given to the chest wall and regional lymph nodes. Following breast-conserving surgery (where only the tumor is removed) in patients without lymph node involvement, radiation can be limited to the breast.

If the cancer has spread to one or two of the lymph nodes nearest the tumor, surgical removal of the lymph nodes in the armpit (the axilla) is necessary unless radiation therapy is planned. If radiation is planned, removal of these nodes is not essential. 

These are general guidelines for treatment. It is important to note that not every member of the panel agreed on each point. Every patient is different, and the best course of treatment for each patient will depend on the specifics of their situation.