ERBB2 and metastatic malignant neoplasm in the lymph nodes: We report a durable response in a patient with advanced metastatic breast cancer treated with a multimodal "press-pulse" metabolic strategy.<h4>Case presentation</h4>A 49-year-old female from Torino, Italy presented with Stage IV (cT4N1M1) invasive ductal carcinoma (HR+/HER2-, grade 3) with extensive osseous and lymph node metastases, poor performance status (ECOG 3) and severe, debilitating pain.