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Oligoprogression — SCE Medical Oncology MCQ

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HardBreast CancerOligoprogressionSCE Medical Oncology

A 73-year-old woman with ER+/HER2- metastatic breast cancer achieves stable disease on first-line letrozole + palbociclib. After 14 months, she develops isolated bone progression (new T12 vertebral metastasis) while other sites remain stable. What management approach may be appropriate?

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Correct answer: D — Continue palbociclib + letrozole and add local treatment (SABR/radiotherapy) to the oligoprogressive site

Oligoprogression (limited disease progression at 1-2 sites while other disease remains controlled) is an increasingly recognised clinical scenario. Continuing effective systemic therapy while adding local ablative treatment (SABR, surgery, radiotherapy) to the progressing site can extend time on current therapy and delay the need for treatment switch. This approach is supported by retrospective data and is being evaluated prospectively.

Reference: ESMO 2024 Metastatic Breast Cancer Living Guideline; Palma et al Lancet 2019 (SABR-COMET)