Hormone Receptor-Positive HER2-Negative Oligometastatic Breast Cancer: prognostic stratification and pattern of progression.

Authors

Jean-Louis Lacaze, Bastien Cabarrou, Thibaut Cassou-Mounat, Ciprian Chira, Celine Dalmasso, Eleonora De Maio, Eva Jouve, Clément Korenbaum, Carole Massabeau, Vincent Nicolai, François Poumeaud, Gabrielle Selmes, Mony Ung

Published in

The oncologist. Oct 19, 2026. Epub Oct 19, 2026.

Abstract

The management of oligometastatic breast cancer (OMBC) remains controversial, particularly regarding selection for local ablative treatment (LAT). In HR+/HER2- OMBC, where prolonged survival is often the case, improved stratification and characterization of progression may guide treatment. We aimed to define prognostic subsets, assess the contribution of Modern-Imaging-Methods (MIMs; 18F-FDG-PET/CT or WB-MRI) to LAT selection, and describe progression after first-line therapy in these subgroups of patients.
All consecutive patients with HR+/HER2- OMBC treated at our institution between 2012 and 2020 were included. OMBC was defined as ≤ 5 metastases. Prognostic factors including biological subtype, anatomical distribution, imaging modality, and LAT were evaluated for overall and progression-free survival (OS, PFS).
Among 145 patients (median follow-up 82.8 months), median OS and PFS were, respectively, 81.1 and 26.5 months. Luminal-A-like subtypes, absence of liver metastases, and use of MIMs independently predicted better survival. LAT improved PFS (hazard ratio [HR]=0.52; 95%CI[0.29-0.91], p=0.0233) and showed a trend toward longer OS. In patients staged with MIMs, LAT significantly improved both OS (HR = 0.29; 95%CI[0.12-0.73], p=0.008) and PFS (HR = 0.40; 95%CI[0.21-0.77], p=0.0064). After first-line systemic therapy, only 18% developed polymetastatic progression.
In HR+/HER2- OMBC, three actionable considerations emerge: staging must incorporate modern imaging to accurately define metastatic burden; LAT may be considered in selected patients with low-grade disease, absence of liver metastases, and long disease-free interval; in oligoprogression after first-line therapy, LAT should be re-evaluated within a multidisciplinary setting. These data offer pragmatic benchmarks to individualize treatment while awaiting definitive randomized evidence.

PMID:
42898011
Bibliographic data and abstract were imported from PubMed on 20 Oct 2026.

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