In the final segment of a case-based discussion, moderator Adam M. Brufsky, MD, PhD, notes that a 1 cm tumor remains in the left breast approximately 1 year after initial non-surgical treatment for a patient with stage IV, HR-positive, HER2-negative metastatic breast cancer. At this point, the disease remains relatively stable.

In the absence of prospective data, Edith A. Perez, MD, would ask a surgeon to evaluate the patient for removal of the lesion. In this situation, based on her experience, Perez believes the patient will benefit from surgery and, if the tumor returns, it will generally present in the same location. Since tests are not available to predict the outcomes of local control surgery, Andrew D. Seidman, MD, generally waits a year-and-a-half to two years before determining if surgery is appropriate.

To help explore this further, the TBCRC 013 study is examining the prospective value of the 21-gene recurrence score at evaluating the effectiveness of surgery for patients presenting with stage IV breast cancer. The impact of surgery in this analysis is still under investigation but the study holds a great deal of potential, believes Hope S. Rugo, MD, since circulating tumors cells and tissue samples were collected.