Metastasis-directed ablation fails to improve PFS in oligometastatic breast cancer trial

The NRG-BR002 phase II/III randomized trial compared first-line systemic therapy alone versus systemic therapy plus metastasis-directed ablation (mostly SBRT) in 125 patients with oligometastatic breast cancer (up to 4 metastases). The trial reported no significant difference in progression-free survival (median 23.0 vs 19.5 months, HR 0.92) or overall survival between arms, and did not proceed to phase III; the authors concluded ablation should not be routinely used outside clinical trials except for palliation. An exploratory analysis suggested a possible PFS benefit with ablation in patients with low or absent pretreatment circulating tumor cells.

Most relevant for: Patients with oligometastatic breast cancer (up to four metastases) receiving first-line systemic therapy who are being considered for metastasis-directed ablation.

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