Lack of efficacy to systemic chemotherapy for treatment of metaplastic carcinoma of the breast in the modern era

Brief Report

Abstract

Metaplastic carcinoma of the breast (MCB) is a rare subtype of breast cancer. Anecdotal reports are available regarding its response to systemic chemotherapy. We reviewed the records of patients diagnosed with MCB at National Taiwan University Hospital between 1988 and 2009. A total of 46 MCB cases were identified from 8,695 breast tumor patients who underwent biopsy or resection. About 11 of 25 patients with initial bulky disease (T3-4) received neoadjuvant chemotherapy before surgery, and 2 (18.2%) exhibited a partial response. About 12 of 18 patients who developed distant metastasis received palliative systemic chemotherapy. Of them, only 1 (8.3%), 1 (10%), and none (0%) responded to first-, second-, or third- and beyond line chemotherapy, respectively. None of the patients who received anthracyline- (n = 13), vinorelbine- (n = 7), or cyclophosphamide-based (n = 18) chemotherapy responded, whereas 3 (17.6%) of 17 patients who received taxane-based chemotherapy exhibited a partial response. Tumor response to systemic chemotherapy remains generally poor for MCB patients. Taxanes may have modest activity, but need to be validated in further studies.

Keywords

Metaplastic carcinoma of breast Neoadjuvant chemotherapy Chemotherapy 

References

  1. 1.
    Al Sayed AD, El Weshi AN, Tulbah AM, Rahal MM, Ezzat AA (2006) Metaplastic carcinoma of the breast clinical presentation, treatment results and prognostic factors. Acta Oncol 45:188–195. doi:10.1080/02841860500513235 PubMedCrossRefGoogle Scholar
  2. 2.
    Gibson GR, Qian D, Ku JK, Lai LL (2005) Metaplastic breast cancer: clinical features and outcomes. Am Surg 71:725–730PubMedGoogle Scholar
  3. 3.
    Tavassoli FA (1992) Classification of metaplastic carcinomas of the breast. Pathol Annu 27(Pt 2):89–119PubMedGoogle Scholar
  4. 4.
    Ellis IOSS, Sastre-Garau X (eds) (2003) Metaplasitc carcinoma. IARC Press, LyonGoogle Scholar
  5. 5.
    Pezzi CM, Patel-Parekh L, Cole K, Franko J, Klimberg VS, Bland K (2007) Characteristics and treatment of metaplastic breast cancer: analysis of 892 cases from the National Cancer Data Base. Ann Surg Oncol 14:166–173. doi:10.1245/s10434-006-9124-7 PubMedCrossRefGoogle Scholar
  6. 6.
    Carlson RW, Allerd DC, Anderson BO, Burstein HJ, Carter WB et al (2011) NCCN clinical practice guidelines in oncology. Breast cancer (Version 1.2011). American Society of Clinical Oncology, Alexandria, LAGoogle Scholar
  7. 7.
    Hennessy BT, Giordano S, Broglio K, Duan Z, Trent J, Buchholz TA, Babiera G, Hortobagyi GN, Valero V (2006) Biphasic metaplastic sarcomatoid carcinoma of the breast. Ann Oncol 17:605–613.PubMedCrossRefGoogle Scholar
  8. 8.
    Luini A, Aguilar M, Gatti G, Fasani R, Botteri E, Brito JA, Maisonneuve P, Vento AR, Viale G (2007) Metaplastic carcinoma of the breast, an unusual disease with worse prognosis: the experience of the European Institute of Oncology and review of the literature. Breast Cancer Res Treat 101:349–353PubMedCrossRefGoogle Scholar
  9. 9.
    Rayson D, Adjei AA, Suman VJ, Wold LE, Ingle JN (1999) Metaplastic breast cancer: prognosis and response to systemic therapy. Ann Oncol 10:413–419PubMedCrossRefGoogle Scholar
  10. 10.
    Therasse P, Arbuck SG, Eisenhauer EA, Wanders J, Kaplan RS, Rubinstein L, Verweij J, Van Glabbeke M, van Oosterom AT, Christian MC, Gwyther SG (2000) New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 92:205–216PubMedCrossRefGoogle Scholar
  11. 11.
    Cardoso F, Bedard PL, Winer EP, Pagani O, Senkus-Konefka E, Fallowfield LJ, Kyriakides S, Costa A, Cufer T, Albain KS (2009) International guidelines for management of metastatic breast cancer: combination vs sequential single-agent chemotherapy. J Natl Cancer Inst 101:1174–1181. doi:10.1093/jnci/djp235 PubMedCrossRefGoogle Scholar
  12. 12.
    Gasparini G, Dal Fior S, Panizzoni GA, Favretto S, Pozza F (1991) Weekly epirubicin versus doxorubicin as second line therapy in advanced breast cancer. A randomized clinical trial. Am J Clin Oncol 14:38–44PubMedCrossRefGoogle Scholar
  13. 13.
    Kaklamani VG, Gradishar WJ (2003) Epirubicin versus doxorubicin: which is the anthracycline of choice for the treatment of breast cancer? Clin Breast Cancer 4(Suppl 1):S26–S33PubMedCrossRefGoogle Scholar
  14. 14.
    Lopez M, Papaldo P, Di Lauro L, Vici P, Carpano S, Conti EM (1989) 5-Fluorouracil, adriamycin, cyclophosphamide (FAC) vs. 5-fluorouracil, epirubicin, cyclophosphamide (FEC) in metastatic breast cancer. Oncology 46:1–5PubMedCrossRefGoogle Scholar
  15. 15.
    De Lena M, Maiello E, Lorusso V, Brandi M, Calabrese P, Romito S, Mazzei A, Marzullo F (1989) Comparison of CHOP-B vs CEOP-B in “poor prognosis” non-Hodgkin’s lymphomas. A randomized trial. Med Oncol Tumor Pharmacother 6:163–169PubMedGoogle Scholar
  16. 16.
    Nielsen OS, Dombernowsky P, Mouridsen H, Daugaard S, Van Glabbeke M, Kirkpatrick A, Verweij J (2000) Epirubicin is not superior to doxorubicin in the treatment of advanced soft tissue sarcomas. The experience of the EORTC Soft Tissue and Bone Sarcoma Group. Sarcoma 4:31–35PubMedCrossRefGoogle Scholar
  17. 17.
    Saad ED, Katz A, Buyse M (2010) Overall survival and post-progression survival in advanced breast cancer: a review of recent randomized clinical trials. J Clin Oncol 28:1958–1962PubMedCrossRefGoogle Scholar
  18. 18.
    Chien T, Chou J, Chang T, Lin C (2010) Successful treatment of biphasic metaplastic sarcomatoid carcinoma of the breast by evaluation of immunohistochemical markers. Hematol Oncol Stem Cell Ther 3:89–93. doi:10.5144/1658-3876.2010.89 PubMedGoogle Scholar
  19. 19.
    Penel N, Van Glabbeke M, Marreaud S, Ouali M, Blay JY, Hohenberger P (2010) Testing new regimens in patients with advanced soft tissue sarcoma: analysis of publications from the last 10 years. Ann OncolGoogle Scholar
  20. 20.
    Moulder S, Moroney J, Helgason T, Wheler J, Booser D, Albarracin C, Morrow PK, Koenig K, Kurzrock R (2011) Responses to liposomal doxorubicin, bevacizumab, and temsirolimus in metaplastic carcinoma of the breast: biologic rationale and implications for stem-cell research in breast cancer. J Clin Oncol 29(19):e572–e575PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2011

Authors and Affiliations

  • I. C. Chen
    • 1
  • C. H. Lin
    • 1
  • C. S. Huang
    • 2
  • H. C. Lien
    • 3
  • Chiun Hsu
    • 1
    • 4
  • W. H. Kuo
    • 2
  • Y. S. Lu
    • 1
    • 4
  • A. L. Cheng
    • 1
    • 4
  1. 1.Department of OncologyNational Taiwan University HospitalTaipeiTaiwan
  2. 2.Department of SurgeryNational Taiwan University HospitalTaipeiTaiwan
  3. 3.Department of Pathology and Graduate Institute of PathologyCollege of Medicine, National Taiwan UniversityTaipeiTaiwan
  4. 4.Department of Internal MedicineCollege of Medicine, National Taiwan UniversityTaipeiTaiwan

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