Kefah Mokbel, Chair of Breast Cancer Surgery at London Breast Institute and Honorary Professor of Medicine at Cardiff University School of Medicine, shared a post on LinkedIn:
“New Evidence Supports Primary Tumour Resection in De Novo Single Site Metastatic Breast Cancer.
A newly published cohort study in JAMA Surgery provides important evidence supporting the value of local therapy in selected patients with oligometastatic breast cancer. The findings of this study are aligned with our previously published analysis.
The study analysed 22,433 patients with de novo single site metastatic breast cancer treated between 2010 and 2020. Despite the potential benefits of local therapy, the majority of patients (67.7 percent) did not receive any surgical or locally ablative intervention.
Several important findings emerged.
Primary tumour resection alone was associated with a significant improvement in overall survival with a hazard ratio of 0.62 compared with patients who received no local therapy.
The combination of breast tumour resection and ablative treatment of the metastatic site was also associated with improved survival with a hazard ratio of 0.60.
Interestingly, metastatic site ablation alone was not associated with improved outcomes and was linked to worse survival with a hazard ratio of 1.22.
Bone only disease represented the most common metastatic presentation, accounting for nearly 69 percent of cases.
These findings reinforce the potential biological importance of controlling the primary tumour in de novo metastatic breast cancer and support a more nuanced approach in carefully selected patients with limited metastatic burden.
The data also suggest that when invasive local therapy is considered, resection of the breast primary may be a critical component of the treatment strategy rather than focusing solely on ablating metastatic deposits.
As systemic therapies continue to improve outcomes in metastatic breast cancer, the integration of surgery and locally ablative approaches deserves renewed attention within multidisciplinary care.
Several biological mechanisms may explain this observation. Removal of the primary tumour can reduce tumour burden, potentially limit further metastatic dissemination, and may influence tumour host immune interactions. As systemic therapies continue to improve survival, the potential impact of controlling the primary tumour becomes increasingly relevant.”
Title: Locally Ablative Therapies in Oligometastatic Breast Cancer
Authors: Tori C. Nierenberg, Samantha M. Thomas, Ian Halliday, Astrid Botty van den Bruele, Ton Wang, Laura H. Rosenberger, Meghan R. Flanagan, Gayle A. DiLalla, E. Shelley Hwang, Jennifer K. Plichta.
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