Poor response to neoadjuvant chemotherapy in metaplastic breast carcinoma

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 M...

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Autores principales:	Willard Wong, Edi Brogi, Jorge S. Reis-Filho, George Plitas, Mark Robson, Larry Norton, Monica Morrow, Hannah Y. Wen
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/dfb94e25ff8d460f8dd36265079a5e88
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spelling	oai:doaj.org-article:dfb94e25ff8d460f8dd36265079a5e882021-12-02T16:43:44ZPoor response to neoadjuvant chemotherapy in metaplastic breast carcinoma10.1038/s41523-021-00302-z2374-4677https://doaj.org/article/dfb94e25ff8d460f8dd36265079a5e882021-07-01T00:00:00Zhttps://doi.org/10.1038/s41523-021-00302-zhttps://doaj.org/toc/2374-4677Abstract 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.Willard WongEdi BrogiJorge S. Reis-FilhoGeorge PlitasMark RobsonLarry NortonMonica MorrowHannah Y. WenNature PortfolioarticleNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENnpj Breast Cancer, Vol 7, Iss 1, Pp 1-7 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Willard Wong Edi Brogi Jorge S. Reis-Filho George Plitas Mark Robson Larry Norton Monica Morrow Hannah Y. Wen Poor response to neoadjuvant chemotherapy in metaplastic breast carcinoma
description	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.
format	article
author	Willard Wong Edi Brogi Jorge S. Reis-Filho George Plitas Mark Robson Larry Norton Monica Morrow Hannah Y. Wen
author_facet	Willard Wong Edi Brogi Jorge S. Reis-Filho George Plitas Mark Robson Larry Norton Monica Morrow Hannah Y. Wen
author_sort	Willard Wong
title	Poor response to neoadjuvant chemotherapy in metaplastic breast carcinoma
title_short	Poor response to neoadjuvant chemotherapy in metaplastic breast carcinoma
title_full	Poor response to neoadjuvant chemotherapy in metaplastic breast carcinoma
title_fullStr	Poor response to neoadjuvant chemotherapy in metaplastic breast carcinoma
title_full_unstemmed	Poor response to neoadjuvant chemotherapy in metaplastic breast carcinoma
title_sort	poor response to neoadjuvant chemotherapy in metaplastic breast carcinoma
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/dfb94e25ff8d460f8dd36265079a5e88
work_keys_str_mv	AT willardwong poorresponsetoneoadjuvantchemotherapyinmetaplasticbreastcarcinoma AT edibrogi poorresponsetoneoadjuvantchemotherapyinmetaplasticbreastcarcinoma AT jorgesreisfilho poorresponsetoneoadjuvantchemotherapyinmetaplasticbreastcarcinoma AT georgeplitas poorresponsetoneoadjuvantchemotherapyinmetaplasticbreastcarcinoma AT markrobson poorresponsetoneoadjuvantchemotherapyinmetaplasticbreastcarcinoma AT larrynorton poorresponsetoneoadjuvantchemotherapyinmetaplasticbreastcarcinoma AT monicamorrow poorresponsetoneoadjuvantchemotherapyinmetaplasticbreastcarcinoma AT hannahywen poorresponsetoneoadjuvantchemotherapyinmetaplasticbreastcarcinoma
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Poor response to neoadjuvant chemotherapy in metaplastic breast carcinoma

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