Do you start systemic therapy for patients with previously localized HR+ breast cancer developing solitary bone metastasis which is now triple negative if there are no other sites of disease after metastasis-directed radiation?  

I would start chemotherapy because of the triple-negative status of the metastasis. This is a patient who initially presented with hormone receptor-positive breast cancer and subsequently developed an isolated bone metastasis that was triple negative. The question of systemic therapy post-localized ...

I would use caution when applying CALOR to this patient. The old saying is "biology is king" (and I've been told appropriately "stage is queen"). CALOR examined the benefit of chemotherapy following a local recurrence of disease. That is a different biology than the development of distant metastatic...

Would confirm that discordance is a true change in receptor status and not a function of assessment of receptors on the bone which can lead to false negative results.

I would not favor giving 'adjuvant' chemotherapy in this situation. First, the ER status of bone biopsies can be unreliable due to decalcification giving false negative results; I have had ER+ patients with multiple bone metastases and 'ER-' results on bone biopsies who clearly benefited from endocr...

This is a difficult question and is best handled with shared decision-making with the patient (this will be a long discussion). CALOR is not relevant as it focused on local regional recurrences only where the goal of care was cure. This is metastatic, incurable disease, currently NED. Data does not ...

This is my favorite kind of clinical question because there are no right answers, but no wrong ones either. We are operating in a data-free environment here. As has already been discussed, the CALOR trial provides some support for the idea of chemo after definitive management of an isolated rec...

In addition to many of the above comments, I would confirm with an expert/multidisciplinary path review that it is TNBC and not metastasis from another primary site.

Approximately 70% of all advanced breast cancer patients develop bone metastases during their disease with 51% of patients presenting bone only disease at first relapse. (Coleman & Rubens, PMID 3814476) The first recurrence of breast cancer should be biopsied to determine ER, PR, and HER2 status...