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Treating Stage IV Breast Cancer: Who, What, Where and When?
Significant advances in systemic treatment options have positively impacted breast cancer survivorship. Patients of all subtypes are living longer than ever, rendering the optimal selection of who to treat with radiation whether for local control of the primary site, oligometastatic site, or oligoprogressive disease, an important choice that we make in daily clinical practice. Available literature is conflicting and confusing to interpret, with the different timing of treatments and selection of (or lack of) the Stage IV women for whom we would consider a more aggressive treatment. Many clinicians find themselves in the precarious position of discussing with multispecialty colleagues the difficult cases where the saying ‘absence of evidence is not evidence of absence’ applies. There is an increasing need to develop clinical guidelines and dialogue for decision making around this patient population, as none currently exist.
The activity is opened by Dr. Eileen Connolly who discusses the results of BR002 and CURB to give a brief review, including the limitations of the randomized data around the oligometastatic population. She also discusses some of the retrospective data that encourages oligometastatic treatment, helping to model a nuanced approach to this very heterogeneous patient population. Next, Dr. Seema Khan comprehensively reviews the literature for primary breast treatment in the context of metastatic disease, including the results of the trial for which she was PI, EA2108. Next, Dr. Michael Yan offers his take on how to practically approach treatment of the primary in stage IV patients, and how to incorporate response to systemic therapy and extent of oligometastases in the shared decision-making process with the patient. He also discusses the field and fractionation options available to us.
Topics:
- One Too Many? What We Know So Far About Oligometastatic Breast Cancer
Eileen P. Connolly, MD, PhD - Primary Source - Treating the Primary in Stage IV Patients
Seema A. Khan, MD - Dealer's Choice - Knowing When to Treat
Michael Yan, MD, MPH - Case Discussions / Q&A
Julie C. Choi, MD - Moderator
Full Panel
This activity is available from August 19, 2025, through 11:59 p.m. Eastern time on August 18, 2027.
The content was originally presented and recorded at the 2024 ASTRO Annual Meeting.
Target Audience
The activity is designed to meet the interests of medical oncologists, radiation oncologists, surgeons, nurses and residents.
Learning Objectives
Upon completion of this activity, participants should be able to:
- Stratify patients in a formulaic way, so that consistency in treatment decision making can be developed, while recognizing the unique needs of each patient and clinic; academic versus clinical.
- Synthesize the available data regarding treatment for both oligometastatic disease and the breast primary in the setting of metastatic disease.
- Know the most supported fractionation schemes for oligometastatic disease and primary breast disease.
- Julie C. Choi, MD, is employed by Columbia University.
- Seema A. Khan, MD, is employed by Northwestern University Robert H. Lurie Comprehensive Cancer Center.
- Eileen P. Connolly, MD, PhD, is employed by Columbia University. Dr. Connolly receives grant/research funding from Merck and Eisai. Dr. Connolly owns stock and stock options in BMS.
- Michael Yan, MD, MPH, is employed by Princess Margaret Cancer Centre, University of Toronto. Dr. Yan receives compensation from Need, Inc.
The person(s) above served as the developer(s) of this activity. Additionally, the ASTRO Education Committee had control over the content of this activity. All relevant financial relationships have been mitigated.
The American Society for Radiation Oncology (ASTRO) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Available Credit
- 1.00 AMA PRA Category 1 Credit™
The American Society for Radiation Oncology (ASTRO) is accredited by the Accreditation Council for Continuing Medical Education for physicians. ASTRO designates this Enduring material for a maximum of 1.00 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
- 1.00 Certificate of AttendanceThis activity was designated for 1.00 AMA PRA Category 1 Credit™.
Price
Course Fees:
ASTRO members must log in to the ASTRO website to view and receive the member rate.
- Nonmember: $149
- Member: $99
- Member-in-Training: $49
- Student/Graduate Student/PGY-1 Member: $49
- Postdoctoral Fellow Member: $49
If you are an ASTRO member from a low or lower-middle income country, as identified by the World Bank, you can receive a 50% discount off your corresponding registration for this activity. Please email [email protected] to inquire about the discount.
Policies:
No refunds, extensions, or substitutions will be made for those participants who, for any reason, have not completed the activity by the expiration date.
Participants using ASTRO Academy activities to satisfy the requirement of a Continuing Certification (MOC) program should verify the credit number and type and availability dates of any activity before making a purchase. No refunds, extensions, or substitutions will be made for participants who have purchased activities that do not align with their MOC requirement.
The activity and its materials will only be available on the ASTRO website until August 18, 2027, regardless of purchase date. At the expiration of the activity, participants will no longer have access to the activity or its materials. ASTRO reserves the right to remove an activity before its expiration date.
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