Patients with advanced disease may benefit from surgery, radiotherapy or chemotherapy. Considering the possibility of disease stabilization and / or improvement of quality of life. One should not forget the multidisciplinary team , but the cure is not what you expect and attention to the possibility of dysthanasia.

above standard of care therapies

also consider immunotherapy

I agree with Vivek, immunotherapy including mAb and standard treatment are useful in these patients.

It's now well known that stage IV cancer is rarely cured by standard therapies. I request all brilliant minds to suggest some novel therapies, which are non-toxic and affordable to all. If we succeed, this discussion will become a historic part of cancer research.

Depends very much on 1) the type of cancer and its biology; 2) the patient and their premorbid state and; 3) how aggressive and novel we plan to be. New treatments like the biologicals and immunotherapy are changing the way we look at previously considered terminal cancer (such as metastatic melanoma and lung cancer). The use of the controversial Caris testing to determine potential chemotherapetic agents and novel therapies such as SIRT spheres and targeted radio peptide/radioimmunotherapy are altering the way we look at treating certain end-stage cancers. New radiotherapy techniques, though expensive, such as gamma knife and proton therapy also offer further potential treatment options in different clinical scenarios. My group is having very good success in stage IV prostate cancer and somatostatin receptor expressing tumours with targeted radio peptide therapy (see www.theranostics.com.au). More of such agents and further new techniques are coming on line so there is hope but still much to do and much to learn.

I agree with Lenzo, in a word, case-by-case analysis.

Respected Lenzo sir, did you able to cure stage IV cancer in humans completely ?

We never use the word "cure" however we have achieved long term (>10 year) sustained remissions with combination radiosensitizing chemotherapy and radio peptide therapy in metastatic neuroendocrine tumours and also using radioimmunotherapy in CD20 positive NHL (published data).

I can say, at least theoretically, long term (>10 year) sustained remissions are as good as cure. Can your therapy be used for other stage IV cancers also ?

If we can find an appropriate molecular signature on a tumour to target (which we do with PET) then we can usually offer treatment. For example I have 2 patients with Iodine negative Ga-68 octreotate positive progressive and symptomatic metastatic follicular thyroid cancer which I am treating with Lutetium177 octreotate radio peptide therapy combined with radiosensitizing chemotherapy and monitoring treatment response based on thyroglobulin assessment, FDG PET and Ga-octreotate PET. This is described in the literature and in our experience is safe, effective and very well tolerated.  It is however expensive - PET is around $700 USD per scan and treatment around $7K USD per cycle. If interested further check out www.theranostics.com.au