Beat Thürlimann – författare

This RRCR-conference-volume marks "number six" in a 20-year evolution of international conferences on the adjuvant therapy of primary breast cancer. Starting in 1978, a handful of some 80 en­ thusiastic breast cancer surgeons and oncologists, met in a se­ cluded mountain resort near st. Gallen in Eastern Switzerland, to exchange their early data of some pioneer trials on adjuvant sys­ temic therapy of early breast cancer, and to correlate their future research efforts to overcome the frustrating prognostic stagna­ tion of this dominant neoplastic disease in Western females dur­ ing the past decades. Repeated every 3-4 years, these St. Gallen International Conferences on Adjuvant Therapy of Primary Breast Cancer have continuously grown in numbers of partici­ pants and in normative, therapeutic influence by being published in major oncology journals [1-3], the last (6th) conference hav­ ing taken place from February 25-28, 1998 with more than 1800 attendees from over 50 countries worldwide. What is the fascination of adjuvant therapy in primary (early) breast cancer, and what has changed,during the last 3 years since March 1995, to justify another international gathering of this size, and of the world's leading experts in the field? There is no question, that providing even more effective care and designing appropriate recommendations for the multitudes of patients with so-called early breast cancer or at high risk of developing the disease, remain highly important public health goals.

This book provides a clinically oriented overview on the patho-physiological background and the use of bisphosphonates in oncology. The clinical development of pamidronate to treat tumor-induced hypercalcemia and malignant osteolytic bone disease is demonstrated, as well as the results of pivotal studies. New important findings on how to best use pamidronate in certain indications are given and put in perspective. The author discusses patient management guidelines as well as pharmaco-economic aspects important for the readers.

We often hear physicians, health care professionals, poli­ ticians, and patient advocates that "nothing has happened in the treatment of breast cancer," since patients with breast cancer, the most frequent neoplastic condition in women in industrialized countries, are continuing to suffer relapse and succumb to this dreadful disease! This negativistic attitude does not seem to be justified, but, why is the transmission of clinical trial results into general practice, and with it progress, such a slow process? After many decades of frustrating stagnation of long-term survival expectations, in all stages of early, oper/lble breast cancer treated only by surgery and locoregional radio­ therapy, adjuvant systemic therapy (chemo- as well as endocrine treatments) clearly showed to significantly benefit in terms of disease-free and overall survival. This evolution has been extensively expounded on by the Worldwide Oxford Overview and the Expert Consensus Panel at the fourth International Conference 'on Adjuvant Therapy of Primary Breast Cancer in St. Gallen (Early Breast Cancer Trialists' Collaborative Group 1992; Glick et al. 1992). What has happened since then? During the past 3-5 years, several new concepts and treatment strategies have emerged and have been studied in various major breast cancer groups and treatment centers worldwide. Some of these can already be considered to assist in the primary treatment of operable breast cancer today, while others are . still undergoing clini,cal trials for better definition of their practical usefulness.