What is the optimal management of Krukenberg tumor in a pre-menopausal woman with HR pos metastatic breast cancer, progressed on Tamoxifen and second line Gemcitabine, with the rest of the disease sites well controlled?

If the Krukenberg tumor is the only site of metastasis or active disease in a premenopausal patient with HR+ metastatic breast cancer, I will recommend a complete surgical resection of the tumor together with B/L oophorectomy to render her surgical menopausal.

There is no definite data to show survival benefit in metastasectomy in breast cancer but antedotal data did suggest benefit of disease control in selected case like oligometastasis situation. In this case, another reason for the surgery + oophorectomy is to take this opportunity to render her surgical menopause, then there will be opportunity to use other antiestrogen therapy such as AI +/- CDK 4/6 inhibitor.