Oligometastatic Breast Cancer: How to Manage It?

Barberi, Vittoria; Pietragalla, Antonella; Franceschini, Gianluca; Marazzi, Fabio; Paris, Ida; Cognetti, F.; Masetti, Riccardo; Scambia, Giovanni; Fabi, Alessandra

doi:10.3390/jpm11060532

Cited by 10 publications

(13 citation statements)

References 73 publications

(97 reference statements)

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“…There is a subset of patients with metastatic breast cancer who present with limited disease, termed ‘oligometastatic’ breast cancer [ 67 ]. Oligometastatic breast cancer is defined as metastatic disease with limited spread and thus it may be possible to achieve longer survival in this select patient population [ 67 ].…”

Section: Resultsmentioning

confidence: 99%

HR+/HER2– Advanced Breast Cancer Treatment in the First-Line Setting: Expert Review

et al. 2023

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The approval of CDK4/6 inhibitors has dramatically improved care for the treatment of HR+/HER2– advanced breast cancer, but navigating the rapidly-expanding treatment evidence base is challenging. In this narrative review, we provide best-practice recommendations for the first-line treatment of HR+/HER2– advanced breast cancer in Canada based on relevant literature, clinical guidelines, and our own clinical experience. Due to statistically significant improvements in overall survival and progression-free survival, ribociclib + aromatase inhibitor is our preferred first-line treatment for de novo advanced disease or relapse ≥12 months after completion of adjuvant endocrine therapy and ribociclib or abemaciclib + fulvestrant is our preferred first-line treatment for patients experiencing early relapse. Abemaciclib or palbociclib may be used when alternatives to ribociclib are needed, and endocrine therapy can be used alone in the case of contraindication to CDK4/6 inhibitors or limited life expectancy. Considerations for special populations—including frail and fit elderly patients, as well as those with visceral disease, brain metastases, and oligometastatic disease—are also explored. For monitoring, we recommend an approach across CDK4/6 inhibitors. For mutational testing, we recommend routinely performing ER/PR/HER2 testing to confirm the subtype of advanced disease at the time of progression and to consider ESR1 and PIK3CA testing for select patients. Where possible, engage a multidisciplinary care team to apply evidence in a patient-centric manner.

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Section: Resultsmentioning

confidence: 99%

HR+/HER2– Advanced Breast Cancer Treatment in the First-Line Setting: Expert Review

et al. 2023

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“…Stereotactic body radiotherapy (SBRT) and IMRT seem to be safe and associated with good outcomes. In several studies, patients with oligometastatic breast cancer and well-controlled primary were treated with SBRT targeting all metastatic sites, and progression-free survival ranged from 50% to 70% at two years [ 18 , 19 ]. The optimal ablative therapy for endobronchial oligometastases should ideally be decided in a multidisciplinary meeting including surgeons, radiation oncologists, and interventional radiologists’ input [ 18 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

Isolated Endobronchial Metastasis of Breast Cancer Successfully Managed With Multimodal Treatment

Rais,

Maskrout,

Mokfi

et al. 2023

Cureus

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Isolated endobronchial metastases of breast cancers, without other visceral metastatic involvement, are exceptional. We report here an observation of isolated endobronchial metastasis discovered 18 months after complete treatment of breast carcinoma. The endobronchial metastasis was revealed by an incoercible cough and hemoptysis. A bronchoscopy revealed a budding tumor process obstructing the right stem bronchus and a biopsy was performed. The anatomopathological and immunohistochemical analysis confirmed the metastatic nature of the endobronchial tumor. The patient received treatment with palbociclib and aromatase inhibitors. Two years after radiotherapy and under hormone treatment, the patient is in complete remission of her breast cancer and endobronchial metastasis. Emerging research suggests that oligometastatic breast cancer carries a superior prognosis. We believe that patients with oligometastatic breast cancer should be treated with curative intent, including ablative therapy to all sites of disease if it can be safely accomplished. This approach may offer an additional chance for prolonged survival.

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“…Thus, it is very difficult to conduct a perfect random trial about the local therapy for primary stage IV breast cancer in a real world. Of particular note is oligometastatic disease, which can achieve long-term remission and even be cured through different treatment strategies ( 23 ). The BOMET MF14-01 study showed that bone metastasis only (especially oligometastatic bone and solitary bone) may take more advantage from local surgery ( 24 ).…”

Section: Discussionmentioning

confidence: 99%

Conditional cause-specific survival after chemotherapy and local treatment for primary stage IV breast cancer: A population-based study

Xiao

Zhang²

2022

Front. Oncol.

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BackgroundConditional survival (CS) represents the probability of surviving for additional years after the patient has survived for several years, dynamically describing the survival rate of the patient with the varying time of survival. The aim of this study was to evaluate the conditional cause-specific survival (CCSS) after chemotherapy and local treatment for metastatic breast cancer, and to identify the prognostic factors affecting the CCSS.MethodsPatients diagnosed with primary stage IV breast cancer in the Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015 were included. CS is defined as the probability of additional survival for y years after the patient had survived x years with the calculation formula CCSS (x | y) = CSS (x + y)/CSS (x), where CSS(x) indicates the patient’s cause-specific survival rate at the time of x years. Cox proportional hazard models were used to evaluate predictors of CCSS.ResultsA total of 3,194 patients were included. The 5-year CSS was 39%, whereas the 5-year CCSS increased to 46%, 57%, 71%, and 85% after the diagnosis of 1, 2, 3, and 4 years. For patients with adverse clinical pathological features, CCSS had more pronounced increase with survival time and is more different from the CSS at diagnosis. No matter at the time of diagnosis or 1 year or 3 years after diagnosis, HER2 status, local treatment, and multisite metastasis were independent prognostic factors that affect the long-term survival of patients (all P < 0.05).ConclusionThe 5-year CCSS of patients with stage IV breast cancer was extended as the survival years increased. HER2 status, multisite metastasis, and local treatment were independent prognostic factors even 3 years after diagnosis.

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Oligometastatic Breast Cancer: How to Manage It?

Cited by 10 publications

References 73 publications

HR+/HER2– Advanced Breast Cancer Treatment in the First-Line Setting: Expert Review

HR+/HER2– Advanced Breast Cancer Treatment in the First-Line Setting: Expert Review

Isolated Endobronchial Metastasis of Breast Cancer Successfully Managed With Multimodal Treatment

Conditional cause-specific survival after chemotherapy and local treatment for primary stage IV breast cancer: A population-based study

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