Advertisement

Neoadjuvant Chemotherapy for Metaplastic Breast Cancer: Response Rates, Management, and Outcomes

Published:January 28, 2022DOI:https://doi.org/10.1016/j.clbc.2022.01.006

      ABSTRACT

      Introduction

      Neoadjuvant chemotherapy (NAC) for breast cance has not been well studied for metaplastic breast cancer (MBC), a rare but aggressive type of breast cancer.

      Materials and Methods

      The National Cancer Database was queried (2004-2017) for females with cM0 MBC who received NAC and definitive surgery with a pathologic staging record. Statistics included Kaplan-Meier overall survival (OS) analysis, multivariable logistic regression, and Cox proportional hazards modeling.

      Results

      Of 903 MBC patients, 88 (9.8%) experienced a pathologic complete response (pCR). The vast majority of ypT0 cases were initially cT1-2. On multivariable logistic regression, cT1 disease was a single factor that was associated with pCR. The majority of patients with MBC undergoing pCR still underwent mastectomy (62.5%) and sentinel node biopsy (67.1%). Axillary dissection was more common in non-pCR cases (49.3% vs. 29.6%, P = .001). The 5 year OS difference amongst MBC patients between pCR vs. RCB1-3 was significant (93 vs. 63%, P < .001). There was no difference observed between MpBC with pCR and non-MpBC invasive ductal carcinoma (IDC) with pCR (93 vs. 93%), with pCR (P > .05 for all molecular subtypes).

      Conclusion

      This study confirms that response rates of MBC to NAC are low, with pCR being relatively infrequent. However, early-stage MBC may be more likely to achieve pCR. These findings combined with emerging research on identifying favorable histopathologic subtypes of MBC may better elucidate subsets with higher proclivity for pCR, especially because these patients achieve satisfactory survival, comparable to that of IDC with pCR.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Clinical Breast Cancer
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • Schwartz TL
        • Mogal H
        • Papageorgiou C
        • Veerapong J
        • Hsueh EC.
        Metaplastic breast cancer: histologic characteristics, prognostic factors and systemic treatment strategies.
        Exp Hematol Oncol. 2013; 2: 31
        • Yu JI
        • Choi DH
        • Huh SJ
        • et al.
        Unique characteristics and failure patterns of metaplastic breast cancer in contrast to invasive ductal carcinoma: a retrospective multicenter case–control study (KROG 13-07).
        Clin Breast Cancer. 2015; 15: e105-e115
        • Haque W
        • Verma V
        • Naik N
        • Butler EB
        • Teh BS.
        Metaplastic breast cancer: practice patterns, outcomes, and the role of radiotherapy.
        Ann Surg Oncol. 2018; 25: 928-936
        • Polamraju P
        • Haque W
        • Cao K
        • et al.
        Comparison of outcomes between metaplastic and triple-negative breast cancer patients.
        Breast. 2020; 49: 8-16
        • Chen IC
        • Lin CH
        • Huang CS
        • et al.
        Lack of efficacy to systemic chemotherapy for treatment of metaplastic carcinoma of the breast in the modern era.
        Breast Cancer Res Treat. 2011; 130: 345-351
        • Early Breast Cancer Trialists’ Collaborative Group
        Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomised trials.
        Lancet Oncol. 2018; 19: 27-39
        • Ladipo OL
        • Ren Y
        • Caddell KB
        • et al.
        Does treatment sequence affect outcomes in patients with metaplastic breast cancer?.
        Am J Surg. 2021; 221: 701-705
        • Bilimoria KY
        • Stewart AK
        • Winchester DP
        • et al.
        The national cancer data base: a powerful initiative to improve cancer care in the United States.
        Ann Surg Oncol. 2008; 15: 683-690
        • Corso G
        • Frassoni S
        • Girardi A
        • et al.
        Metaplastic breast cancer: Prognostic and therapeutic considerations.
        J Surg Oncol. 2021; 123: 61-70
        • Moreno AC
        • Lin YH
        • Bedrosian I
        • et al.
        Outcomes after treatment of metaplastic versus other breast cancer subtypes.
        J Cancer. 2020; 11: 1341-1350
        • Al-Hilli Z
        • Choong G
        • Keeney MG
        • et al.
        Metaplastic breast cancer has a poor response to neoadjuvant systemic therapy.
        Breast Cancer Res Treat. 2019; 176: 709-716
        • Masua N
        • Lee SJ
        • Ohtani S
        • et al.
        Adjuvant capecitabine for breast cancer after preoperative chemotherapy.
        N Engl J Med. 2017; 376: 2147-2159
        • Von Minckwitz G
        • Huang CS
        • Mano MS
        • et al.
        Trastuzumab emtansine for residual invasive HER2- positive breast cancer.
        N Engl J Med. 2019; 380: 617-628
        • Han M
        • Salamat A
        • Zhu L
        • et al.
        Metaplastic breast carcinoma: a clinical-pathologic study of 97 cases with subset analysis of response to neoadjuvant chemotherapy.
        Mod Pathol. 2019; 32: 807-816
        • Wong W
        • Brogi E
        • Reis-Filho JS
        • et al.
        Poor response to neoadjuvant chemotherapy in metaplastic breast carcinoma.
        NPJ Breast Cancer. 2021; 22: 96
        • Leyrer CM
        • Berriochoa CA
        • Agrawal S
        • et al.
        Predictive factors on outcomes in metaplastic breast cancer.
        Breast Cancer Res Treat. 2017; 165: 499-504
        • El Zein D
        • Hughes M
        • Kumar S
        • et al.
        Metaplastic carcinoma of the breast is more aggressive than triple- negative breast cancer: a study from a single institution and review of the literature.
        Clin Breast Cancer. 2017; 17: 391-392
        • Tadros AB
        • Sevilimedu V
        • Giri DD
        • et al.
        Survival outcomes for metaplastic breast cancer differ by histologic subtype.
        Ann Surg Oncol. 2021; 28: 4245-4253
        • Haque W
        • Verma V
        • Butler EB
        • Teh BS.
        Omission of radiotherapy in elderly women with early stage metaplastic breast cancer.
        Breast. 2018; 38: 154-159