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2.  AGO Recommendations for Diagnosis and Treatment of Patients with Advanced and Metastatic Breast Cancer: Update 2013 
Breast Care  2013;8(3):181-185.
doi:10.1159/000353590
PMCID: PMC3728631  PMID: 24415967
Guidelines; Locoregional relapse; Metastatic breast cancer; Targeted therapy
3.  13th St. Gallen International Breast Cancer Conference 2013: Primary Therapy of Early Breast Cancer Evidence, Controversies, Consensus – Opinion of a German Team of Experts (Zurich 2013) 
Breast Care  2013;8(3):221-229.
Summary
The International Consensus Conference on the treatment of primary breast cancer takes place every two years in St. Gallen, Switzerland. The panel in St. Gallen is composed of international experts from different countries. From a German perspective, it seems reasonable to interpret the voting results in the light of AGO-recommendations and S3-guidelines for everyday practice in Germany. Consequently, a team of eight breast cancer experts, of whom two are members of the international St. Gallen panel, commented on the voting results of the St. Gallen Consensus Conference (2013). The main topics at this year's St. Gallen conference were surgical issues of the breast and axilla, radio-therapeutic and systemic treatment options, and the clinical relevance of tumour biology. The clinical utility of multigene assays for supporting individual treatment decisions was also intensively discussed.
doi:10.1159/000351692
PMCID: PMC3728634  PMID: 24415975
St. Gallen Consensus; Early breast cancer; Adjuvant therapy; Multigene signatures; Targeted therapy
5.  St. Gallen 2013: Brief Preliminary Summary of the Consensus Discussion 
Breast Care  2013;8(2):102-109.
Summary
The 2013 St. Gallen Consensus Conference on early breast cancer provided mostly evidence-based, globally valid treatment recommendations for breast cancer care, with a broad spectrum of acceptable clinical practice. This report summarizes the results of the 2013 international panel voting procedures with regard to loco-regional and endocrine treatment, chemotherapy, targeted therapy as well as adjuvant bisphosphonate use. This report is not aimed to replace the official St. Gallen Consensus publication, some recommendations may even be altered in the final paper, but should serve a preliminary rapid report of this important meeting.
doi:10.1159/000351193
PMCID: PMC3683952  PMID: 24000280
Early breast cancer; Bisphosphonates; Endocrine therapy; Chemotherapy; Surgery; Axillary dissection; Targeted therapy; Neoadjuvant therapy
6.  ABC1 Consensus Conference – a German Perspective 
Breast Care  2012;7(1):52-59.
A group of German breast cancer experts (medical oncologists and gynaecologists) reviewed and commented on the results of the first international ‘Advanced Breast Cancer First Consensus Conference’ (ABC1) for the diagnosis and treatment of advanced breast cancer. The ABC1 Conference is an initiative of the European School of Oncology (ESO) Metastatic Breast Cancer Task Force in cooperation with the EBCC (European Breast Cancer Conference), ESMO (European Society of Medical Oncology) and the American JNCI (Journal of the National Cancer Institute). The main focus of the ABC1 Conference was metastatic breast cancer (stage IV). The ABC1 consensus is based on the vote of 33 breast cancer experts from different countries and has been specified as a guideline for therapeutic practice by the German expert group. It is the objective of the ABC1 consensus as well as of the German comments to provide an internationally standardized and evidence-based foundation for qualified decision-making in the treatment of metastatic breast cancer.
doi:10.1159/000336049
PMCID: PMC3335349  PMID: 22553474
ABC1-consensus; Metastatic breast cancer, diagnosis and staging, treatment; Tumor markers; Metastases, biopsy; Chemotherapy; Endocrine therapy; Anti-HER2-targeted therapy; Palliative care
7.  Re-Challenging Taxanes in Recurrent Breast Cancer in Patients Treated with (Neo-)Adjuvant Taxane-Based Therapy 
Breast Care  2011;6(4):279-283.
Summary
Background: Docetaxel and paclitaxel are among the most active substances for the treatment of breast cancer. As both drugs are used today in adjuvant regimens, efficacy data from pivotal trials in the metastatic setting in taxane-naive populations cannot reliably be used as references. Patients and Methods: The Taxane Re-Challenge Cohort Study identified participants from 6 prospective (neo-)adjuvant taxane-based studies with recurrent disease and collected data on their subsequent treatment. Out of 381 recurrent patients, 106 (27.8%) were re-challenged with a taxane-based treatment as first- or later-line therapy for recurrent disease. Results: Taxanes were used as first-line therapy in 74 patients and showed a response rate of 48.6% (including complete responses in 27.0%). The response rate was dependent on the disease-free interval (<1 year: 34.8%; 1-2 years: 42.9%; >2 years: 63.3%; p = 0.04) and visceral metastasis (present: 62.5%; not present 32.4%; p = 0.01). Patients without visceral metastasis and with a disease-free interval of >2 years achieved the longest overall survival. Hormone and HER2 receptor status were not predictive; however, triple-negative tumors responded in 50.0%. The overall response rate of later-line taxane-based treatment was 28.2%. Conclusion: Re-challenging taxanes appears to be effective and therefore represents a reasonable option in this population.
doi:10.1159/000330946
PMCID: PMC3225212  PMID: 22164126
Docetaxel; Paclitaxel; Adjuvant; Recurrent breast cancer
9.  Clinical Recommendations of DEGRO and AGO on Preferred Standard Palliative Radiotherapy of Bone and Cerebral Metastases, Metastatic Spinal Cord Compression, and Leptomeningeal Carcinomatosis in Breast Cancer 
Breast Care  2010;5(6):401-407.
Summary
Background
To provide guidance for clinical practice on preferred standard palliative radiotherapy (RT) of different sites of metastasis for breast cancer patients based on current published evidence complemented by expert opinion.
Methods
The breast cancer expert panel of the German Society for Radiation Oncology (DEGRO) and members of the Working Party of Gynecologic Oncology (AGO) Breast Committee formulated recommendations based on the panel's interpretation of the level of evidence referring to the criteria of evidence-based medicine added to the AGO grades of recommendation.
Results
For different types and sites of metastasis, distinct therapeutic goals (alleviation of symptoms, pain relief, local tumor control, prevention or improvement of neurological deficits, stabilization of the spine or other bones) require complex approaches considering individual factors (i.e. life expectancy, tumor progression at other sites). With regard to different therapeutic goals, different dose concepts and fractionation schedules, and single-versus multi-fraction palliative RT should be adapted individually.
Conclusions
RT is an effective tool in palliation treatment of bone metastasis (BM), cerebral metastasis (CM) and metastatic spinal cord compression (MSCC), or leptomeningeal carcinomatosis (LC) and plays a central role in an interdisciplinary approach. Preferred technique, targeting, and different dose schedules are described in detail in the DEGRO guidelines, which are also integrated in the updated 2010 AGO recommendations.
doi:10.1159/000322661
PMCID: PMC3076353  PMID: 21494406
Metastatic breast cancer; Palliative radiation therapy; Bone metastasis; Cerebral metastasis; Metastatic spinal cord compression; Leptomeningeal carcinomatosis
11.  St. Gallen 2011: Summary of the Consensus Discussion 
Breast Care  2011;6(2):136-141.
Summary
The 2011 St. Gallen Consensus Conference on early breast cancer provided mostly evidence-based treatment recommendations with a broad spectrum of acceptable clinical practice for global breast cancer care. This report summarizes the results of the 2011 international panel voting procedures with regard to locoregional and endocrine treatment, chemotherapy, targeted therapy as well as adjuvant bisphosphonate use.
doi:10.1159/000328054
PMCID: PMC3100376  PMID: 21633630
Early breast cancer; Bisphosphonates; Endocrine therapy; Chemotherapy; Surgery; Targeted therapy; Neoadjuvant therapy
12.  Future Roles of Lapatinib in ErbB2-Positive Breast Cancer: Adjuvant and Neoadjuvant Trials 
Breast Care  2010;5(Suppl 1):22-24.
Summary
Lapatinib is potentially an ideal therapy for the adjuvant and neoadjuvant treatment of women with breast cancer due to its convenience of use (oral, once-daily administration) and because it has shown activity in the first-line and refractory metastatic settings. Furthermore, the dual tyrosine kinase inhibitor appears to have a low incidence of cardiotoxicity, and may decrease the rate of later brain metastases. Therefore, several cooperative groups and academic centers have initiated trials investigating lapatinib in the treatment of early-stage ErbB2 (HER2)-overexpressing breast cancer.
doi:10.1159/000285778
PMCID: PMC2931097  PMID: 20847929
Lapatinib; ErbB2-positive breast cancer; Adjuvant; Neoadjuvant; ALTTO study; TEACH study
13.  Cognitive Effects of Systemic Therapy in Patients with Breast Cancer 
Breast Care  2009;4(3):177-182.
Summary
Many patients with breast cancer complain about concentration and memory problems in connection with systemic therapy. A number of studies investigating the possible decrease in cognitive abilities were published in the 1980s. Numerous studies showed impaired performance of patients receiving chemotherapy. The results concerning profile, extent, and duration of cognitive impairments are, however, non-uniform. Increasing interest has been focused in the last years on effects of endocrine therapy on cognitive capacity – especially concerning the effects of the almost complete estrogen depletion caused by aromatase inhibitors. Often, the published studies did not evaluate particular effects of endocrine therapy without considering interference of cytotoxic treatment. Furthermore, the different endocrine medications (antiestrogens vs. aromatase inhibitors) were usually not regarded separately despite different mechanisms of action. Hence, the results of past investigations are also controversial. In the future, prospective trials with larger samples are necessary. Differentiation between chemotherapy and endocrine therapy is essential. Likewise, different types of endocrine therapy should be examined separately.
doi:10.1159/000221543
PMCID: PMC2931005  PMID: 20847877
Breast cancer; Cognitive side effects; Chemotherapy; Endocrine therapy
14.  Zurich Consensus: German Expert Opinion on the St. Gallen Votes on 15 March 2009 (11th International Conference at St. Gallen: Primary Therapy of Early Breast Cancer) 
Breast Care  2009;4(2):109-116.
Summary
A German working group of 23 breast cancer experts discussed the results from the vote at this year's St. Gallen Consensus Conference on Primary Therapy for Early Breast Cancer (March 11–14, 2009) and came up with some concrete recommendations for day-to-day therapeutic decisions in Germany. Due the fact that the concept of the St. Gallen Consensus Conference merely allows for a minimal consensus, the objective of the working group was to provide practice-related recommendations for day-to-day clinical decisions in Germany. One area of emphasis at St. Gallen was tumor biology as a starting point for reaching individual therapeutic decisions. Intensive discussion was necessary with respect to the clinical relevance of predictive and prognostic factors. A new addition to the area of systemic therapy was a first-ever discussion of the adjuvant administration of bisphosponates and the fact that therapy with trastuzumab in HER2 overexpressing breast cancer has been defined as the standard for neoadjuvant therapy. The value of taxanes as a component of (neo)adjuvant chemotherapy as well as the value of aromatase inhibitors for the endocrine adjuvant treatment of postmenopausal patients were affirmed.
doi:10.1159/000212164
PMCID: PMC2931071  PMID: 21049070
15.  The Future of Breast Cancer Management 
Breast Care  2008;3(6):381-382.
doi:10.1159/000185799
PMCID: PMC2931022  PMID: 21048905
17.  German Recommendations for Diagnosis and Treatment of Breast Cancer 2008. What is New from the Breast Commission of the German Gynaecological Oncology Working Group (AGO)? 
Breast Care  2008;3(2):93-99.
Summary
Some form of standardised treatment for patients with breast cancer is probably well established in German health institutions throughout the country. Keeping standards up to date, however, is a rather complex activity involving time and financial resources. Turnover of scientific knowledge is fast and numerous. Most health care professionals will not be able to ensure such kind of evidence-based diagnostics and treatment standards of care alone. The breast commission of the German Gynaecological Oncology Working Group (Arbeitsgemeinschaft Gynäkologische Onkologie, AGO) has again published their yearly update on recommendations for the diagnosis and therapy of breast cancer. Literature was screened for new findings up to the beginning of 2008. Changes were incorporated in nearly all of the 25 chapters. Notably, duration and schedules of adjuvant endocrine therapy, updated adjuvant chemotherapy regimens, findings in plastic surgery, radiotherapy for node positive disease, evaluation of new prognostic and predictive factors, classification of lobular neoplasia, treatment of Paget's disease, inflammatory breast cancer, and sarcoma, as well as lapatinib and bevacizumab are discussed, only to mention a few. Using this easy accessible tool, high quality care can be given to the patient, standards can be communicated and justified to the health care system and new ideas will arise for clinical and pre-clinical development.
doi:10.1159/000127441
PMCID: PMC2931082  PMID: 21373211
Breast cancer; Diagnostics; Treatment; Recommendations
18.  Perspectives on Breast Cancer Management: Tailoring Treatment to the Individual Patient 
Breast Care  2008;3(Suppl 1):21-23.
doi:10.1159/000119749
PMCID: PMC2930993  PMID: 20824005
19.  Adherence to Treatment Guidelines in Breast Cancer Care – a Retrospective Analysis of the ‘Organgruppe Mamma der Arbeitsgemeinschaft Gynaekologische Onkologie’ 
Breast Care  2008;3(2):87-92.
Summary
Background
The Organgruppe Mamma of the Arbeitsgemeinschaft Gynäkologische Onkologie (AGO) performed a nationwide 3-phase analysis of the structure of care and standard of therapy given to patients with breast cancer from 2002 (4th quarter) to 2004 (4th quarter). The extent to which national and international treatment recommendations are implemented in routine clinical practice had so far not been evaluated in an interdisciplinary approach. No reliable data on the pattern of care of these patients have been published in Germany before.
Patients and Methods
The project included early breast cancer in the adjuvant and neoadjuvant setting as well as metastatic disease. We present the results of phase III of the AGO analysis, which are based on a survey conducted by the Organkommission Mamma in the 4th quarter of 2004.
Results
Evaluation of the data reveals that treatment based on the guidelines is now being implemented very reliably in certain sectors. This is of particular relevance to the pattern of adjuvant treatment in early breast cancer. In contrast, in metastatic breast cancer (MBC), the complexity of the interdisciplinary treatment approach is complicating this kind of straightforward analysis.
Conclusion
The present analysis conducted by the AGO was the first attempt to analyse the treatment provided in patients presenting with MBC in a systematic fashion. The fundamental problem remains, irrespective of the stage of the tumour, that too few patients are treated in randomised clinical trials. The mission set by the AGO-Organkommission Mamma is the longitudinal observation of the therapy practices for breast cancer on the basis of the observations discussed here, which should ultimately benefit the optimisation of therapy quality in Germany.
doi:10.1159/000127434
PMCID: PMC2931081  PMID: 21373210
Breast cancer treatment; Healthcare research; Adjuvant treatment; Breast cancer, metastatic; Guideline adherence

Results 1-19 (19)