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. 2019 Aug;176(3):709-716.
doi: 10.1007/s10549-019-05264-2. Epub 2019 May 22.

Metaplastic breast cancer has a poor response to neoadjuvant systemic therapy

Zahraa Al-Hilli  1 , Grace Choong  2 , Michael G Keeney  3 , Daniel W Visscher  3 , James N Ingle  4 , Matthew P Goetz  4 , James W Jakub  5
Affiliations

Metaplastic breast cancer has a poor response to neoadjuvant systemic therapy

Zahraa Al-Hilli et al. Breast Cancer Res Treat. 2019 Aug.

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.

Keywords: Metaplastic breast cancer; Neoadjuvant chemotherapy; Pathological and clinical outcomes.

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Conflict of interest statement

Conflicts of interest 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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