39 yrs old woman with proved breast cancer (IDC, ER+ PR+ HER2-) T1N1M1 (BONE T5+) PET SCAN confirmed T5 involvement only, thorax and liver are normal.
what is your suggestion?
first curative v.s. pallaiative?
second chemotherapy vs endocrinotherapy?
Which bones have been metastasized?
It is important regarding radiotherapy to know the location of the bone metastasis.
Zoledronic acid will decrease pain and decrease metastasis growth.
Endocrine treatment should be administered. I would recommend fulvestrant.
Second line protocols for breast cancer should be used.
Best regards.
Tomas
Dear coleague, I believe endocrine therapy, BRCA testing.
Case mets stabilty it is amainable to local treatment
Consider bone rt
Dear colleague
first what is the percentage of the ER and PR positivity,second what is the kind of metastasis bone condensation or ostéolysis and does she present pain,you can consider hormonotherapy with Tamoxifen because she is 39 old with zoledronic acid and consider local treatment of T5
best regards
Dear Sir,
This patient has proven to be stage 4 disease, hence our intention is palliative. I will subject this patient for chemotherapy starting with anthracyline-based x 3 cycles and switch to taxane-based chemotherapy another 3 cycles. I will start her SERM first as she is premenopausal. With regard to the T5 bone metastasis, I will offer her radiotherapy and management of hypercalcemia is needed if she has it.
Thank you
Dear Colleague
shouldn't we consider that isolated bone metastasis with curative intention?
Dear habibollah.
Curative local intention if disease remains stable under ht
This is my unit's atitude. What do you apply?
Dear college, it's a pity that her status is considered as palliative, especially with solitary bone lesion. This is the guidelines! Nevertheless, have a look at this paper.
Article Bone metastasis in breast cancer is treated by high-dose tamoxifen
Dear colleague
Our institute plan for isolated bone metastasis is curative. After neurosurgery consult because of fear of fracture, If there is no thereat of fracture we will start with chemotherapy
1) this is NOT a curative situation and should not be approached as such.
2) in ER+ tumours, hormone therapy NOT chemotherapy is the treatment initially.
3) Tamoxifen should be used as patient is pre-menopausal, or aromatose inhibitor if block ovarian function with LHRH inhibitors of radiation to ovaries or oophorectomy.
4) Zoledrolic acid (Zometa) every 3 months is helpful as would be any local therapy if she is having pain e.g., spot radiation therapy, kypoplasty, etc.
5) Ibrance (palbociclib) should be considered with letrozol in future or now if block ovaries.
6) play out all hormonal options before considering chemotherapy in future. ER/PR+ tumour respond well and for long period of time with hormonal therapy and poorly and for short periods with chemotherapy.
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