In my experience is often not possible to determine HER2 status (HER2 IHC, CISH, SISH or FISH) in bone metastasis after the mandatory decalcification process.
Anna, metastatic treatment decisions are not always based on the receptor expression of the metastatic lesions. Whilst heterogeneity and altered expression over time is widely acknowledged, a biopsy, or an interpretable biopsy is not always possible.
In this instance, treatment would be based on the expression profile of the primary tumour.
Anna, is this a recurrence case? What treatment has been approached before? Since you mentioned bone metastasis, one treatment that remains a must regardless of chemo/hormone/antibody therapy is the Bisphosphonates treatment. Jaw necrosis is a risk, but the risk-vs-benefit is still in the favor of using them. If an option in your practice, Denosumab can substitute Bisphosphonates (also per NCCN)
Oh..., forgot to mention: check vit D levels and supplement aggressively if needed. I'd be guarded with Vit D+calcium if hypercalcemia has already occurred as a result of bone metastasis; also related to this, I'd keep phos at a minimum until hypercalcemia resolves. I am a big Vit D believer in cancer treatment. It is unfair when we only search for the treatment solution in either the chemo or targeted therapy and forget what else we have on hand to modulate tumor response.
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