Table 4 Major differences in voting results between Egyptian and St Gallen Panels (systemic therapy)
From: Primary therapy of early breast cancer: Egyptian view of 2021 St. Gallen consensus
Survey question | Egyptian Panel | St. Gallen Panel |
|---|---|---|
Neoadjuvant Therapy | ||
 Should regimens improving pCR rates become standard neoadjuvant therapy | If the regimens achieved a remarkable improvement in pCR rates (50% higher than control) (59%) | Only in case of improvement of event-free survival and overall survival endpoints (83%) |
 In clinically positive axillary lymph nodes, and HER2-positive tumors, the treatment should contain: • Platinum- and pertuzumab-containing treatment • Anthracyclines | • Platinum- and pertuzumab-containing Treatment (51%) | • Anthracyclines (62%) |
 In case of stage 2 and 3 clinically node-negative and HER2-positive disease, patients should receive: • Anthracyclines and pertuzumab in addition to taxane and trastuzumab • Pertuzumab and platinum in addition to taxane and trastuzumab | • Anthracyclines and pertuzumab in addition to taxane and trastuzumab (60%) | • Anthracyclines and pertuzumab in addition to taxane and trastuzumab (35%) • Pertuzumab and platinum in addition to taxane and trastuzumab (27%) |
 Do you see PD1/PDL1 testing affecting the recommendation for the use of immune checkpoint inhibitors in the neoadjuvant therapy | Yes (65%) | No (81%) |
Post neoadjuvant treatment | ||
 For patients with ER-positive disease after neoadjuvant endocrine treatment and not achieving pCR, should you offer these patients adjuvant chemotherapy if they had an excellent clinical response and node-negative residual cancer | No (68%) | Yes (100%) |
Extension of endocrine therapy in premenopausal patients | ||
 How to treat high-risk premenopausal patients who had finished 5 years of OFS plus tamoxifen with regards to the type endocrine therapy extension: • Offer OFS (if still premenopausal) plus an aromatase inhibitor • Offer tamoxifen only for 5 years | • Offer OFS (if still premenopausal) plus aromatase inhibitor (68%) | • Offer OFS (if still premenopausal) plus, an aromatase inhibitor (41%) • Offer tamoxifen only for 5 years (45%) |
 In general, in a case of postmenopausal patients with higher anatomical stages like pT3pN1 or >3 infiltrated lymph nodes, do you recommend chemotherapy | Yes (97%) | No (51%) |
New drugs | ||
 Do you recommend offering abemaciclib in ER-positive and HER2-negative patients with more than 3 positive axillary lymph nodes | No (69%) | Yes (54%) |
 In other possible situations as for patients with 1–3-positive lymph nodes or other factors of an unfavorable prognosis such as G3, T3, or high Ki-6, do you recommend the application of abemaciclib | Yes (52%) | No (54%) |