Clinical Challenges in Breast Surgery: Surgical Management of Metastatic Breast Cancer

Behind The Knife: The Surgery Podcast

Medicine, Health & Fitness, Education, Science

4.8 • 1.4K Ratings

🗓️ 5 December 2022

⏱️ 35 minutes

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Summary

De novo metastatic breast cancer represents 6% of all new breast cancer diagnoses. This figure has not changed at all over the past 20 years; however, systemic therapy options have evolved dramatically during this time and have significantly increased life expectancy for these patients. While surgical management of the primary tumor in the setting of metastatic disease has typically been reserved for palliative indications, surgeons are now being asked to consider resecting the primary tumor to potentially increase overall survival. In this episode, we will use a case study to examine the data that should inform our conversations and decisions when we encounter patients with metastatic breast cancer who are interested in having their primary tumor resected.

Links:
§ Khan, S.A., S. Schuetz, and O. Hosseini (2022). Primary-Site Local Therapy for Patients with De Novo Metastatic Breast Cancer: An Educational Review. Ann Surg Oncol; 29: 5811-5820. https://link.springer.com/article/10.1245/s10434-022-11900-x
§ Khan, S.A. et al (2022). Early Local Therapy for the Primary Site in De Novo Stage IV Breast Cancer: Results of a Randomized Clinical Trial (E2108). J Clin Oncol; 40(9): 978-987. https://ascopubs.org/doi/10.1200/JCO.21.02006?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed
§ Badwe, R. et al (2015). Locoregional treatment versus no treatment of the primary tumor in metastatic breast cancer: an open-label randomized controlled trial. Lancet Oncol; 16: 1380-1388. https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(15)00135-7/fulltext
§ Fitzal, F. et al (2019). Impact of Breast Surgery in Primary Metastasized Breast Cancer: Outcomes of the Prospective Randomized Phase III ABCSG-28 POSYTIVE Trial. Ann Surg; 269(6): 1163-1169. https://journals.lww.com/annalsofsurgery/Abstract/2019/06000/Impact_of_Breast_Surgery_in_Primary_Metastasized.24.aspx
§ Soran, A. et al (2018). Randomized Trial Comparing Resection of Primary Tumor with No Surgery in Stage IV Breast Cancer at Presentation: Protocol MF07-01. Ann Surg Oncol; 25: 3141-3149. https://link.springer.com/article/10.1245/s10434-018-6494-6

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Transcript

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0:00.0	It's great to be back on behind the night.
0:24.8	As a reminder, my name is Alexa Glenser and I'm a Chief Resident at UCSF.
0:29.3	I will be doing a breast surgical oncology fellowship at MD Anderson starting next summer.
0:33.7	I'm joined by two of my breast surgery attendings here at UCSF,
0:37.3	Dr. Rita Mukhtar and Dr. Michael Alvarado.
0:40.6	Today, we will be discussing the case of a patient with
0:43.3	denovo metastatic breast cancer who has been responding well to systemic therapy
0:48.2	and is interested in having her primary breast tumor resected.
0:51.7	This is an increasingly common scenario we have been encountering and we wanted to review
0:56.3	the evidence that should inform the decision to operate at the primary tumor in patients with
1:00.6	metastatic disease. I'll begin by introducing our hypothetical patient. She's a 45-year-old woman
1:06.7	diagnosed one year ago with denovo hormone receptor positive, her two positive invasive
1:12.5	ductal carcinoma that had unfortunately already spread beyond her breast to her liver and bones
1:18.4	at the time of diagnosis. She was treated with her septum, progetta, and taxatera.
1:24.6	And is currently only on her septum and progetta to target her to her two disease.
1:30.4	While her liver and bone lesions have decreased substantially in size, her breast tumor has not.
1:36.3	She is referred to you by her medical oncologist for consideration of resection of her primary tumor.
1:41.2	Dr. Alvarado, how would you approach this patient in your clinic?
1:45.0	Yeah, this is a challenging case. Thanks, Alexa, for that introduction. So,
1:50.3	you know, denovo metastatic disease, it happens and it has happened anywhere from five to six
1:57.1	percent of all cases that are diagnosed. So we have seen that for sure. And in my practice over
2:03.1	the last 15 years, I've seen a number of those patients. What's interesting is that with all of
	...

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