New Insights on the Role of Surgery for the Breast Primary Tumor in Patients Presenting With Stage IV Disease

Purpose of Review: Though systemic therapy has been the standard treatment for patients with de novo metastatic breast cancer, a large number of retrospective studies demonstrate that resection of the primary tumor is associated with improved survival. Here, we review the potential rationale for resection, available retrospective and prospective data, and challenges in applying these data in clinical practice. Recent Findings: Results from prospective trials to date are limited. The only published randomized controlled trial concluded that locoregional therapy for the primary tumor did not result in improved overall survival and was associated with shorter distant progression-free survival. Summary: Recommendations regarding the potential survival advantage of locoregional therapy cannot be firmly made until additional results from prospective trials are available. Systemic therapy remains first-line treatment, and surgical resection of the primary tumor should only be considered for select patients after a full discussion of the limitations of the current data.