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. 2021 Jul 22;7(1):96.
doi: 10.1038/s41523-021-00302-z.

Poor response to neoadjuvant chemotherapy in metaplastic breast carcinoma

Willard Wong  1 , Edi Brogi  1 , Jorge S Reis-Filho  1 , George Plitas  2 , Mark Robson  3 , Larry Norton  3 , Monica Morrow  2 , Hannah Y Wen  4
Affiliations

Poor response to neoadjuvant chemotherapy in metaplastic breast carcinoma

Willard Wong et al. NPJ Breast Cancer. .

Abstract

Metaplastic breast carcinoma (MpBC) is a rare special histologic subtype of breast carcinoma characterized by the presence of squamous and/or mesenchymal differentiation. Most MpBCs are of triple-negative phenotype and neoadjuvant chemotherapy (NAC) is frequently utilized in patients with MpBC. The aim of this study was to evaluate response to NAC in a retrospective cohort of MpBCs. We identified 44 patients with MpBC treated with NAC at our center between 2002 and 2018. Median age was 48 years, 86% were clinical stage II-III, and 36% were clinically node-positive. Most (80%) MpBCs were triple-negative or low (1-10%) hormonal receptor positive and HER2 negative on pre-NAC biopsy. While on NAC, 49% showed no clinical response or clinico-radiological progression. Matrix-producing subtype was associated with clinico-radiological response (p = 0.0036). Post NAC, two patients initially ineligible for breast-conserving surgery (BCS) were downstaged to be eligible for BCS, whereas three patients potentially eligible for BCS before treatment became ineligible due to disease progression. Only one (2%) patient had a pathologic complete response (pCR). Among the 16 patients presenting with biopsy-proven clinical node-positive disease, 3 (19%) had nodal pCR. Axillary lymph node dissection was avoided in 3 (19%) patients who had successful axillary downstaging. Residual cancer burden (RCB) was assessed in 22 patients and was significantly associated with disease-free survival and overall survival. We observed a poor response or even disease progression on NAC among patients with MpBC, suggesting that NAC should be reserved for patients with inoperable MpBC.

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Conflict of interest statement

J.S.R.-F. reports receiving personal/consultancy fees from Goldman Sachs, REPARE Therapeutics and Paige.AI, membership of the scientific advisory boards of VolitionRx, REPARE Therapeutics and Paige.AI, membership of the Board of Directors of Grupo Oncoclinicas, and ad hoc membership of the scientific advisory boards of Roche Tissue Diagnostics, Ventana Medical Systems, Novartis, Genentech and InVicro, outside the scope of this study. The remaining authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Flow chart of surgical treatment.
MpBC metaplastic breast cancer, NAC neoadjuvant chemotherapy, BCS breast conversing surgery. *Patient’s choice.
Fig. 2
Fig. 2. Representative micrograph of the pre-neoadjuvant treatment core biopsy of the sole patient who had pathologic complete response.
Note that the core biopsy revealed a matrix-producing metaplastic carcinoma, poorly differentiated. Magnification ×200.
See this image and copyright information in PMC

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