# Understanding breast cancer complexity to improve patient outcomes: The St Gallen International Consensus Conference for the Primary Therapy of Individuals with Early Breast Cancer 2023

Source: https://onco.cc/key-papers/paper-st-gallen-2023-consensus-ann-oncol-2023/  
OnCo record `paper-st-gallen-2023-consensus-ann-oncol-2023` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The 2023 report of the international expert panel that meets every two years to vote on how early breast cancer should be treated, this time stressing multidisciplinary decisions and the right intensity and duration of treatment.

## Summary

Report of the 18th St Gallen International Breast Cancer Conference, held in March 2023 in Vienna, by Curigliano, Burstein, Gnant, Loibl and colleagues. The panel assessed new findings for local and systemic therapy of early breast cancer with a focus on multimodal options, emphasised multidisciplinary discussion of the clinical benefit of interventions as integral to a plan with the right degree of intensity and duration, concentrated on ductal (no special type) and lobular histologies, and framed its opinions as interpretations of data shaped by practice environments, patient factors and reimbursement and access constraints worldwide, while advocating participation in well-designed clinical studies.

## Fields

- Kind: Key paper
- Last checked: 2026-09-24
- Tags: tnbc-evidence
- Journal: Annals of Oncology
- Year: 2023
- DOI: 10.1016/j.annonc.2023.08.017
- Authors: Curigliano G, Burstein HJ, Gnant M, et al.
- Findings: Consensus emphasises multidisciplinary treatment planning with the right degree of intensity and duration.; Panel opinions explicitly account for reimbursement and accessibility constraints around the world.
- What it means: St Gallen is where de-escalation questions in triple-negative disease (who needs the full KEYNOTE-522 regimen, who can skip adjuvant pembrolizumab) are first put to a vote; the 2023 panel framed intensity and duration as the central problem.
- Caveats: Expert consensus by vote, not a systematic review.; Recommendations are for early disease and largely for common histologies.

## Sources

- Ann Oncol 2023: https://doi.org/10.1016/j.annonc.2023.08.017
- PubMed: https://pubmed.ncbi.nlm.nih.gov/37683978/

## Connected records

- cancers: [HER2-positive breast cancer](https://onco.cc/cancers/breast-her2-positive/), [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/), [Triple-negative breast cancer (TNBC)](https://onco.cc/cancers/tnbc/)
- terms: [De-escalation, escalation and response-adapted therapy](https://onco.cc/terms/de-escalation/)
- people: [Giuseppe Curigliano](https://onco.cc/people/giuseppe-curigliano/), [Sibylle Loibl](https://onco.cc/people/sibylle-loibl/)
- journals: [Annals of Oncology](https://onco.cc/journals/annals-of-oncology/)
- ideas: [Give exceptional responders less: pembrolizumab omission after complete response, anthracycline-free regimens and chemotherapy omission in lymphocyte-rich stage I disease](https://onco.cc/ideas/idea-tnbc-de-escalation-for-exceptional-responders/)

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