A report from 2014: The prognosis of patients with metastatic breast cancer is very poor. Because of this, treatment of skeletal metastasis is often palliative with limited goals rather than cure. However, there are those patients, such as presented here, who survive for an extended time.

PRESENTATION OF CASE: This 36 year old female presented with lytic lesions to one ulna and rib 5 years after mastectomy for breast cancer. Despite radiation and chemotherapy, the ulnar lesion expanded and resulted in an elbow dislocation. The rib lesion was resected and the arm amputated above the elbow. She developed local recurrence in both her above elbow amputation stump and chest wall and a more proximal below shoulder amputation was performed with resection of chest wall lesion. Even though she had locally aggressive disease, she has survived for 31 years after diagnosis without any evidence of disease.

DISCUSSION: Reports of metastatic breast cancer survival indicate the 5 year survival to be 15%. There have been few reports indicating that those patients with skeletal only or oligometastatic disease have improved prognosis. It is not clear what biological properties of these tumors results in the improved survival.

CONCLUSION: This case highlights the challenges of giving patients the optimal treatment in the light of limited ability to predict prognosis. It also highlights the need to further investigate the phenotypes of breast cancer that can, despite metastatic disease and with modern treatment go on to long survival. In addition this case demonstrates the importance of long term followup.

I have heard occasional stories about success with metronomic therapy. I have inquired about metronomic therapy with my MO and he was not opposed to it but noted that in his experience, it hasn't worked well on the patients he has seen. I still may consider it at some point. The theory is that there is an immunogenic response and that the constant therapy doesn't let the endothelial cells grow, among other impacts from the specific treatments.

JFL, I know right? And not just once, first it was amputated above the elbow, and then later amputated at the shoulder. Plus she had at least a section of a rib removed. And let's not forget that she had a breast amputated (maybe both?). I know that quality of life concerns about treatment is a highly personal decision for each of us, but I'm pretty sure I personally couldn't repeatedly continue to cut off parts of my body every time cancer reared it's ugly head.

There's a local woman I've come to know who has been living with MBC for over 20 years now (since 1998). She's an outspoken advocate and very involved in the Metastatic Breast Cancer community. I just saw her again a couple weeks ago when she was a keynote speaker at a metastatic breast cancer conference and she was doing well. She recently wrote a blog post outlining all of the treatments she's had. What's really interesting is that she was originally Triple Negative, then it changed to ER+ and is currently HER2+ too, each time it changed it opened new treatment options for her https://catsncancer.com/2018/10/01/20-years-of-mbc-treatment/

Pam et al, I'm in the Wisconsin study and learned recently that I've made it into the second cohort of outliers. Woo-hoo!

Happy to spit into a tube for science,

Tina