Would you consider surgical management of a TNBC primary after a patient has had radiographic resolution of oligometastatic disease?

Randomized studies have revealed no advantage with removal of primary; however, there is a growing body of evidence in other cancers for treating oligo-metastatic disease with curative intent. Breast cancer is not colon cancer, etc but I feel the concept is novel and in the era of highly effective systemic therapy, worth considering. NRG-BR002 is looking at a similar concept.

It would not be unreasonable to consider surgery in a young healthy patient.

A challenging case. The two major randomized clinical trials have shown no benefit of surgery in de novo metastatic disease. However, I still think that a fraction of patients may benefit from prolonged control of disease (disease-free). It is also true that there are patients with oligo liver met who have done very well. With immunotherapy (prolonged disease control) and high-resolution imaging (PET-CT, liver MRI), there are better tools that patients may benefit from introducing local therapy. I am not going to advocate for surgery, but I am willing to explore the opportunity for surgery to work with the multidisciplinary team.