For a patient with metastatic HR positive breast cancer presenting with spinal cord compression but no visceral metastases, what is your recommended first line systemic therapy?

If it is a de-novo metastatic breast cancer, I would start systemic therapy with AI/fulvestrant or CDk4-6/fulvestrant combo. I have a similar patient who has had a long clinical course with only recurrent spinal metastasis leading to cord compression. No visceral metastasis. Monitor with spine MRI p...

I agree with Dr. @Dr. First Last, above. Would add the following comments too:

After local spinal cord directed therapy with surgery and/or radiation (and obtaining tissue and/or cytology) - I would use CDK4/6 inhibitor and ET. Abemaciclib would be my choice, which I believe has the best demonstrated...