Kefah Mokbel, Professor of Medicine (Honorary) at Cardiff University School of Medicine, shared on LinkedIn:
“De novo oligometastatic breast cancer: when should we add local treatment?
The 2026 Assisi Think Tank Meeting, named after Assisi, Italy, brings together international breast cancer experts.
It is endorsed by ESTRO and AIRO, under the auspices of EUSOMA.
Systemic therapy remains the foundation, and local treatment requires careful patient selection. A limited number of metastases alone does not establish a survival benefit from surgery or ablative radiotherapy.
A proposed pathway informed by the review, not a validated algorithm:
Establish disease extent and biology
Review staging, metastatic sites, subtype, symptoms and performance status with the multidisciplinary team. Address diagnostic uncertainty, particularly when a solitary suspected metastasis determines treatment intent.
Identify the treatment goal
If local treatment is needed for symptom control, assess appropriate surgery or radiotherapy alongside systemic management. Distinguish this from elective consolidation intended to improve long-term outcomes.
Start with systemic therapy before elective consolidation
Initiate subtype-appropriate systemic treatment. Reassess after an induction period, typically 3-8 months, to identify sustained disease control.
Let reassessment guide the next decision
With progression or widespread disease, reassess systemic treatment and use local therapy for specific clinical indications.
With a sustained response or at least stable disease, and persistently limited burden, discuss possible consolidation within the multidisciplinary team.
Assess the primary tumour and metastases separately
Is treatment of breast and regional nodes justified? Is metastasis-directed treatment justified?
Consider feasibility, toxicity, systemic treatment interruption, preferences and trial eligibility. Treating the primary does not automatically justify ablating metastases.
Low burden, bone-only disease and responsive subtypes may indicate a better prognosis. They are not validated predictors of benefit from local treatment.
Optimise treatment when proceeding
Prefer a prospective trial or registry. Use contemporary breast radiotherapy schedules where appropriate, assess systemic therapy-radiotherapy combinations individually, and minimise avoidable treatment interruptions.
Why the caution?
Most randomised primary-tumour trials have not demonstrated an overall-survival benefit. Metastasis-directed evidence remains mixed: NRG-BR002 and the breast cohort of EXTEND did not demonstrate a progression-free survival benefit.
Preliminary OLIGOMA results are encouraging but limited by early closure and small accrual.
What outcome are we aiming to improve, and what evidence supports local treatment?
How does your team select patients for consolidation after systemic therapy?
De Felice et al. Radiotherapy and Oncology, 2026.”
Title: Navigating treatment for De novo oligometastatic breast cancer: The Assisi think tank meeting
Authors: F. De Felice, S. Pedretti, I. Palumbo, Y. Atagun, M. C. De Santis, M. Krengli, I. Ratosa, C. E. Coles, M. Arenas, L. J. Boersma, F. Marazzi, I. Meattini, P. Poortmans, C. Aristei, B. Offersen, O. Kaidar-Person
You can also read: NRG-BR002: Metastasis-Directed Ablation Fails to Improve PFS or OS in Oligometastatic Breast Cancer.
