Hormone receptor–positive HER2-negative oligometastatic breast cancer: prognostic stratification and pattern of progression
Abstract
Background: 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.
Materials and Methods: 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).
Results: 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 = .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 = .008) and PFS (HR = 0.40; 95% CI: 0.21-0.77, P = .0064). After first-line systemic therapy, only 18% developed polymetastatic progression.
Conclusion: In HR+/HER2− OMBC, 3 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.
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BibTeX
@article{lacaze2026hormone,
title = {{Hormone receptor–positive HER2-negative oligometastatic breast cancer: prognostic stratification and pattern of progression}},
author = {Jean-Louis Lacaze and Bastien Cabarrou and Thibaut Cassou-Mounat and Ciprian Chira and Celine Dalmasso and Eleonora De Maio and Eva Jouve and Clément Korenbaum and Carole Massabeau and Vincent Nicolai and François Poumeaud and Gabrielle Selmes and Mony Ung},
journal = {The Oncologist},
year = {2026},
month = oct,
doi = {10.1093/oncolo/oyag413},
url = {https://doi.org/10.1093/oncolo/oyag413},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Hormone receptor–positive HER2-negative oligometastatic breast cancer: prognostic stratification and pattern of progression
AU - Jean-Louis Lacaze
AU - Bastien Cabarrou
AU - Thibaut Cassou-Mounat
AU - Ciprian Chira
AU - Celine Dalmasso
AU - Eleonora De Maio
AU - Eva Jouve
AU - Clément Korenbaum
AU - Carole Massabeau
AU - Vincent Nicolai
AU - François Poumeaud
AU - Gabrielle Selmes
AU - Mony Ung
PY - 2026
DA - 2026/10/19
JO - The Oncologist
DO - 10.1093/oncolo/oyag413
UR - https://doi.org/10.1093/oncolo/oyag413
AB - Background: 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. Materials and Methods: 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). Results: 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 = .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 = .008) and PFS (HR = 0.40; 95% CI: 0.21-0.77, P = .0064). After first-line systemic therapy, only 18% developed polymetastatic progression. Conclusion: In HR+/HER2− OMBC, 3 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.
SN - 1083-7159
SN - 1549-490X
ER -