Jason A. Mouabbi, Assistant Professor of Breast Medical Oncology at The University of Texas MD Anderson Cancer Center, shared on LinkedIn:
“Should we ablate oligometastatic breast cancer? NRG-BR002 in JCO (Steven Chmura Wendy Woodward et al.) gives us randomized data.
125 patients with ≤4 metastases and no progression on up to 12 months of first-line systemic therapy were randomized to SBRT or surgery to all sites (93% got SBRT) plus systemic therapy, vs systemic therapy alone. 79% had HR+/HER2− disease.
benefit. Median PFS was 19.5 vs 23.0 months (HR 0.92, 95% CI 0.57–1.47), and OS HR was 1.07. The trial didn’t advance to phase 3.
No grade 5 toxicity
The interesting part: an exploratory analysis suggests patients with low or absent CTCs at baseline may get a PFS benefit from ablation. That makes biological sense, since these may be the patients with truly limited disease and less micrometastatic burden.
Bottom line: no routine consolidative SBRT for oligometastatic breast cancer outside a trial. CTC-selected trials will be open soon (NRG trial ClaRity by Chelain Goodman) .
Title: NRG-BR002: A Randomized Phase II/III Trial of Metastasis-Directed Ablation With First-Line Systemic Therapy for Oligometastatic Breast Cancer
Authors: Steven J. Chmura, Kathryn A. Winter, Wendy A. Woodward, Virginia F. Borges, Joseph K. Salama, Hania A. Al-Hallaq, Martha M. Matuszak, Julia R. White
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