LOCOREGIONAL TREATMENT OF STAGE IV BREAST CANCER DEBATE

From Expert Review of Anticancer Therapy

A Debate on Locoregional Treatment of the Primary Tumor in Patients Presenting With Stage IV Breast Cancer

David H Nguyen; Pauline T Truong

Key Issues

• With improved survival with modern systemic treatment for metastatic breast cancer, the incentive to avoid adverse effects of uncontrolled locoregional disease in patients with stage IV breast cancer has increased.
• Locoregional treatment of the primary breast disease has the potential to improve locoregional control in patients with metastatic breast cancer.
• Some retrospective registry-based studies and institutional series suggest an association between locoregional treatment and improved survival. However, the results must be interpreted with caution due to selection bias and limited ability to control for confounding factors.
• The available data suggest that locoregional treatment may be considered in subsets with favorable clinicopathologic characteristics, including young age, good performance status, estrogen receptor-positive tumors, bone-only involvement or limited metastatic disease burden.
• Consensus is lacking regarding the optimal timing of locoregional treatment relative to systemic therapy.
• Prospective randomized controlled trials are underway internationally to address this clinically relevant debate.