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What systemic therapy would you offer a postmenopausal women with oligometastatic sternal disease which developed while on tamoxifen?

Provided the sternal lesion was low volume and treated with curative intent and patient has been on tamoxifen for < 5 years, would you switch to AI or move on to AI+CDK 4/6 inhibitor?
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Would you use AI alone or AI plus CDK4/6 inhibitor ?

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1 Answer
Mednet MemberInvited Expert
Medical Oncology · Penn Medicine, University of Pennsylvania Health System
Answered on

For an isolated sternal metastasis, I would normally refer to radiation oncology for focused radiation, and I would change her hormonal therapy to an aromatase inhibitor, as these patients can have very long survival times. Some patients survive longer than a decade. (Milano MT et al).

Having a single oligometastatic lesion and bone-only metastases are more favorable features than numerous lesions or other sites (Milano M.T., Zhang H., Metcalfe S.K., et al: OM breast cancer treated with curative-intent stereotactic body radiation therapy. Breast Cancer Res Treat 2009; 115: pp. 601-608).

The decision to add CDK4/6 to the AI is a tough one. The patient might do quite well for an extended time on the AI alone, so it would not be unreasonable to...

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