How do you treat patients rendered NED after resection of an isolated lung recurrence of an early stage triple negative breast CA years after adjuvant chemotherapy?

While such patient is at high risk for a subsequent recurrence of metastatic disease, there is no data to suggest that administering 'adjuvant' chemotherapy following resection of a solitary metastasis will improve disease-free or overall survival and thus I would simply continue to observe the patient and treat if/when there are new sites of disease, not even in the unlikely event that the patient's disease at diagnosis was considered so low risk that she never received adjuvant chemotherapy. I would not extrapolate results from the CREATE-X trial to justify giving this patient capecitabine, nor results from IMpassion 130 (if the primary tumor or the solitary metastasis was PD-L1+) to justify administering nab-paclitaxel and atezolizumab.

I preferentially give neoadjuvant therapy before resection. Theoretically, this patient is eligible for atezolizumab and nab-paclitaxel if PDL1 positive (1% or greater).

The benefit of a solitary site removal, regardless of time delay in triple-negative, should not be translated as real into all diseases, particularly triple-negative recurring at any time. I am unfamiliar with any data. Other types of disease with less potential virulent behavior I would not be so aggressive.

I would, therefore, consider immunotherapy if eligible and tolerable. However, there are some considerations in triple-negative that warrant not to give therapy. because the triple-negative disease is a heterogeneous disease. Therefore, if it's the rare indolent subtype...