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Mar 14, 2022
This appears to be a case of de novo HER2+ MBC with an oligometastases to the sternum. Curative, or at least prolonged DFS is a reasonable intent here. First, I assume a thorough look for addtional metastases was performed, including possibly MRI of the skeleton as in my experience it is more sensitive even than PET scan (which should also be performed). I would irradiate the sternal lesion after TCHP, even if the tumor is clinically resolved as toxicity is small and there is some potential benefit for residual disease. If the response in the breast was excellent, I would resect the primary. Although the recent cooperative group trial was negative for survival advantage for resecting the primary in de novo MBC, I believe oligomets in HER2+ might represent a special subgroup where results could be more favorable. After treating known sites of disease, I would place the patient on maintenance HP and endocrine therapy. Would strongly consider ovarian function suppression and an AI for the endocrine component. I do not see a strong rationale for ICI in this case and would not use.
Sep 28, 2023
Pending Moderator approval.
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