Highlights of St Gallen 2015 : Interview with Hans-Joerg Senn, Founding Chairman of the conference

Intro text: 


A few weeks ago the 14th edition of the St Gallen International Breast Cancer Conference took place in Vienna. The first official international St Gallen meeting took place in 1982. More than 30 years of great collaboration and a renowned example of an international initiative in the breast cancer research arena. Nowadays the congress brings together breast cancer experts from all around the world and the consensus recommendations are highly respected. BIG had the great pleasure to ask a few questions to Prof. Hans-Joerg Senn, Founding Chairman of the conference.

Going back 30 years, could you tell us how the idea of the St Gallen conference came about?

Some 35-40 years ago, around 1970-1975, breast cancer was a purely “surgical disease”, and – depending more on geography, than on risk factors – operated women (radical mastectomy was then the standard procedure) were additionally exposed to additional chestwall irradiation, even if the breast was surgically removed in toto. 
Based on excellent animal model work of Skipper and Schabel in the USA, several oncology trial groups started in 1970-75 – initially highly controversial – clinical trials with breast surgery, followed by adjuvant chemotherapy with L-PAM (anticancer drug) [B. Fisher et al in NSABP, USA], with adjuvant CMF (cyclophosphamide, methotrexate, fluorouracil) [G. Bonadonna et al, Milano, Italy] and ourselves with adjuvant LMF (chlorambucil, methotrexate, and fluorouracil combination) [H.J. Senn et al, St. Gallen, Eastern Switzerland], in order to prevent subsequent and mostly fatal tumor dissemination. 
Driven initially by the discordant results of these 3 initial trials, we called a first St. Gallen meeting on the adjuvant treatment of early breast cancer in 1978. Then a second meeting took place in 1982, with representatives from all the groups and centers working in this field world-wide. This was the start of the longstanding St. Gallen breast cancer conference line, which has resulted in final consensus statements about the optimal treatment of early breast cancer. Since the 3rd edition in 1988, the consensus recommendations from the St. Gallen International Breast Cancer Conference have been published after each bi-annual meeting in major oncology journals: first in the JNCI (Journal of the National Cancer Institute), then in the JCO (Journal of Clinical Oncology) and since 1995 in Annals of Oncology. These consensus statements have greatly helped to standardize and ameliorate initial, curatively oriented breast cancer treatment in many parts of the world. Respective “Post-St. Gallen” breast cancer treatment sessions, amplifying these updated bi-annual St. Gallen consensus deliberations have been regularly held in different parts of the world: not only in several European countries, but also in China, Japan and South-America.

How do you expect the St Gallen conference to evolve in the next decade?

When the St. Gallen breast cancer conference line was started some 35 years ago, critical voices predicted that we would “run out of interesting topics after 2 to 3 editions of this unnecessary event…”. Contrary to this pessimistic vision, the perspectives – and with them the problems – of adjuvant therapies of early, operable breast cancer have greatly multiplied over the years. The conference name was therefore changed from “Adjuvant” to “Multimodal Therapy” of early breast cancer, since primary chemo- and/or endocrine therapy, adjuvant radiotherapy, and now increasingly new forms of targeted agents, based on new scientific insight in the process of breast cancer development, are entering the scene of primary, curative treatment of breast cancer. 
With all these new scientific and pharmacological developments in mind, we believe there are still enough issues to be discussed and resolved at future St. Gallen conferences. Some of our longstanding St. Gallen speakers and panelists would even like to see these meetings taking place on an annual basis, paying tribute to the present acceleration in scientific research. However, we have a mutual understanding with the organizers of the European Breast Cancer Conference (EBCC) to alternate our two events, with the bi-annual EBCC always held in March of “even” years (in varying venues across Europe, and ours always taking place in March of “uneven” years, with stable venue, formerly (13 times) in St. Gallen, Switzerland, and just recently, since 2015, in Vienna, Austria.

What were the highlights of the 2015 edition?

These bi-annual St. Gallen International Breast Cancer conferences have always tried to critically review the optimal primary therapy for early breast cancer for most parts of the world where respective multi-modality treatment resources are available. We therefore always intend to present in every new conference edition a certain “balance” between optimizing local therapy (surgery, radiotherapy) and avoiding relapse and dissemination (chemotherapy, immunotherapy), which is finally essential for cure. The closing “consensus statements” have to be of practical value to the whole breast cancer treatment community worldwide – and finally have to benefit as many patients as possible.

During the 2015 St. Gallen breast conference in Vienna, more emphasis than before was placed on the importance of correct local therapy (surgery and adjuvant radiotherapy). We also highlighted interesting new trends in adjuvant systemic therapies for early breast cancer, as new, improved tools in form of “gene signatures” are increasingly able to accurately predict relapse potential and clinical outcome, thus increasingly influencing the necessity and choice of adjuvant cytotoxic treatments, especially in hormone-receptor-positive patients. The updated St. Gallen 2015 consensus statement for the optimal (curative) treatment of early breast cancer is already finalized and will soon be published on line in the Annals of Oncology.

Several months from now – at the latest during the 2015 San Antonio Breast Cancer Conference in December – the chairpersons of the St. Gallen conference process (Alan Coates, Australia; Aron Goldhirsch, Italy-Switzerland; Richard Gelber, USA; Michael Gnant, Austria; Martine Piccart, Belgium; Beat Thuerlimann and myself, Switzerland) will start to design the scientific program for the next (15th) St. Gallen International Breast cancer Conference , which will take place 15 – 18 March 2017, most probably again in the ideal location of Vienna, in Austria.