The Study: This question has been mulled over at tumor boards for years. Now we have the Turkish phase 3 MF07-01 trial to chew on. Inclusion criteria included a surgically-resectable primary tumor (so no cT4), absent contralateral breast/axillary disease, and “good physical condition.” 274 patients with newly-diagnosed untreated metastatic breast cancer were randomized to receive either upfront systemic therapy or standard local therapy with breast conservation/mastectomy plus nodal sampling/dissection and adjuvant radiation as usually indicated all followed by systemic therapy. Interestingly, there was no stipulation on max number of metastatic sites. Rate of overall survival at 5 years was markedly different with and without local therapy at 42% versus 24%, respectively. Unplanned subgroup analyses indicated most of this difference was carried by the 88% of enrollees with hormone receptor-positive (HR 0.64) and/or Her2-negative (HR 0.64) disease, as well as those <55 years old (HR 0.57) and/or with bone-only mets (HR 0.47). Most heartening, OS rates at 3 years were double estimations based on data available when this trial was designed in 2007. Next up? Aggressive distant therapy.
Bottom Line: Among otherwise healthy patients with good prognoses, incorporation of aggressive local therapy prior to systemic therapy for newly-diagnosed non-triple negative metastatic breast cancer may prolong survival. | Soran, Ann Surg Oncol 2018