ASO Author Reflections: Is Intensifying Loco-Regional Treatment in the Early Course of De Novo Stage IV Breast Cancer Reasonable?

Excerpt

In metastatic breast cancer (BC), the goal of primary surgery is locoregional symptom control. However, several institutional and population-based retrospective studies and meta-analyses showed that locoregional treatment (LRT) in addition to systemic therapy (ST) prolongs overall survival while substantially decreasing locoregional progression in de novo stage IV BC.1 The hypotheses on prolongation of overall survival with primary tumor removal are reducing tumor burden while reducing circulation tumor cells, immunomodulatory effect, increase systemic efficacy, increase metastasis sensitivity by eliminating BC stem cells, remove seed source of new metastases, and decrease likelihood of potentially resistant cell lines developing. These studies had selection biases regarding their retrospective nature, but primary tumor removal has been shown to improve survival in other settings, such as metastatic melanoma, renal cell carcinoma, colorectal, lung, and gastric cancer. Retrospective studies showed that survival benefits were significant in patients who underwent primary surgery at diagnosis of Stage IV BC followed by ST. Additionally, there are institutional studies that show early intervention to primary tumors prolongs survival of patients who had ST and reached no evidence of disease.2,3 …