Abstract
Objective
Metaplastic breast cancer (MetaBC) is a rare breast cancer subtype poorly responsive to systemic therapy in the metastatic setting with high recurrence rates in the adjuvant setting. However, limited data exist regarding response to neoadjuvant chemotherapy (NAC). We performed a single institutional study to assess the clinical and pathological complete response rates (pCR) of MetaBC to NAC.
Methods
Mayo Clinic Rochester patients with MetaBC treated with NAC were identified using the institutional medical index. Patient demographics, tumor characteristics, chemotherapy treatment, clinical and pathological response, and long-term outcomes were reviewed. Pathologic response was assessed by direct pathology review (n = 14) or review of outside surgical and pathology reports (n = 4).
Results
Women with MetaBC (n = 18) received NAC from January 1991 to June 2014. The mean age was 50 years (range 33–79) with a mean tumor size of 5.1 cm (range 2.3–11 cm) and 6/18 had pathologically confirmed lymph nodes prior to surgery. The majority (13/18; 72%) were estrogen receptor (ER), progesterone receptor (PR) and HER-2 negative (TNBC), and 1/18 (5.5%) was HER-2 positive. Five had BRCA testing and 2/5 were BRCA-2 positive. The chemotherapy regimens included anthracycline/cyclophosphamide (AC) (n = 1), AC/taxane (n = 3), AC/taxane/platinum (n = 8), taxane/platinum-based regimens (n = 4), taxane/cyclophosphamide (n = 1) and taxane/trastuzumab (n = 1). Five of 18 (28%) progressed on initial treatment including two who developed metastatic disease during NAC. The overall pCR rate was 2/18 (11%).
Conclusion
MetaBC is poorly responsive to NAC, with a pCR rate (11%), that is lower than expected in a predominantly TNBC cohort. MetaBC patients should be considered for clinical trials testing new NAC regimens and in the absence of clinical trial enrollment, MetaBC patients with resectable disease should proceed directly to definitive operative management.
Abbreviations
- AC(T):
-
Adriamycin/cyclophosphamide/(taxane)
- BRCA-2:
-
Breast cancer susceptibility gene-2
- EGFR:
-
Epidermal growth factor receptor
- ER:
-
Estrogen receptor
- HER-2:
-
Human epithelial growth factor-2
- IDC:
-
Invasive ductal carcinoma
- KIT:
-
Stem cell factor receptor
- MetaBC:
-
Metaplastic breast cancer
- NAC:
-
Neoadjuvant chemotherapy
- pCR:
-
Pathologic complete response
- PR:
-
Progesterone receptor
- RCB:
-
Residual Cancer Burden
- TNBC:
-
Triple-negative breast cancer
- TP:
-
Taxane/platinum
- TC:
-
Taxane/cyclophosphamide
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Funding
Supported by Mayo Clinic Breast Specialized Program of Research Excellence Grant No. P50CA116201 (J.N.I. and M.P.G.), Mayo Comprehensive Cancer Center Grant No. P30CA 15083-43 (M.P.G.).
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ZAH and GC contributed equally to the data collection and interpretation, intellectual content and manuscript preparation. MGK and DWV reviewed pathology slides and assisted with manuscript preparation. JNI, MPG, and JWJ assisted with funding, intellectual content and manuscript preparation.
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Matthew P. Goetz has consulting or advisory role: Eli Lilly, Novartis, Context Therapeutics, and Sermonix. Research Funding: Eli Lilly, Pfizer. Patents, Royalties, Other Intellectual Property: Methods and Materials for Assessing Chemotherapy Responsiveness and Treating Cancer; Methods and Materials for Using Butyrylcholinesterases to Treat Cancer. The other authors declare they have no competing interests and are in compliance with ethical standard.
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This study was reviewed and approved by Mayo Clinic institutional review board committee under study ID: 14-008981.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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Al-Hilli, Z., Choong, G., Keeney, M.G. et al. Metaplastic breast cancer has a poor response to neoadjuvant systemic therapy. Breast Cancer Res Treat 176, 709–716 (2019). https://doi.org/10.1007/s10549-019-05264-2
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DOI: https://doi.org/10.1007/s10549-019-05264-2