Treatment progress of metaplastic breast cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZHANG Linxing ¹ , HOU Lingmi ¹ , QIAN Shuangqiang ¹ , HOU Jing ¹ ,  GAO Yanchun ¹ , LI Chaoyang ²

1. Department of Thyroid and Breast Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P. R. China;
2. North Sichuan Medical College, Nanchong, Sichuan 637000, P. R. China;

Corresponding author：

GAO Yanchun, Email: boyang11111@163.com

Keywords：

metaplastic breast cancer; treatment progress; targeted therapy

DOI：

10.7507/1007-9424.202309085

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To understand the current progress of surgical treatment, radiotherapy, chemical drug therapy, endocrine therapy, targeted therapy, and immunotherapy of metaplastic breast cancer (MBC), so as to provide reference for the clinical therapy selection of MBC. Method The literature relevant to MBC therapy research in recent years was comprehensively reviewed. Results At present, the pathogenesis of MBC was not clear. The histopathology of MBC was more complex and the prognosis was poor. Compared with the invasive ductal carcinoma, the MBC patients had older age of onset, larger tumor diameter, faster growth and stronger invasiveness. The simple mastectomy was currently used in surgical treatment. The axillary lymph node involvement rate of MBC patients was lower, so the sentinel lymph node biopsy was widely used. The chemical drug therapy, endocrine therapy, and targeted therapy had limited effects on MBC patients. However, with its unique molecular expression by the genomic analysis of MBC and rise of precision medicine, targeted therapy and immunotherapy had become current research hotspots, providing potential therapeutic strategies for MBC patients. Conclusions Due to the complex histopathology and poor prognosis of MBC, and most research on MBC is retrospective studies, lacking sufficient prospective studies with sufficient sample size, so there is currently no clear consensus on the optimal treatment method for MBC. In order to better improve prognosis of MBC patients, further in-depth research on MBC histopathology, prospective studies with sufficient sample size, and development of targeted and effective therapeutic drugs are needed in the future.

Citation： ZHANG Linxing, HOU Lingmi, QIAN Shuangqiang, HOU Jing, GAO Yanchun, LI Chaoyang. Treatment progress of metaplastic breast cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(1): 109-114. doi: 10.7507/1007-9424.202309085 Copy

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2.	Reddy TP, Rosato RR, Li X, et al. A comprehensive overview of metaplastic breast cancer: clinical features and molecular aberrations. Breast Cancer Res, 2020, 22(1): 121. doi: 10.1186/s13058-020-01353-z.
3.	Huvos AG, Lucas JC Jr, Foote FW Jr. Metaplastic breast carcinoma. Rare form of mammary cancer. N Y State J Med, 1973, 73(9): 1078-1082.
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6.	Nagtegaal ID, Odze RD, Klimstra D, et al. The 2019 WHO classification of tumours of the digestive system. Histopathology, 2020, 76(2): 182-188.
7.	Thapa B, Arobelidze S, Clark BA, et al. Metaplastic breast cancer: characteristics and survival outcomes. Cureus, 2022, 14(8): e28551. doi: 10.7759/cureus.28551.
8.	McMurtry V, Cleary AS, Ruano AL, et al. Metaplastic breast carcinoma: clinicopathologic features and recurrence score results from a population-based database. Am J Clin Oncol, 2023, 46(12): 559-566.
9.	McMullen ER, Zoumberos NA, Kleer CG. Metaplastic breast carcinoma: update on histopathology and molecular alterations. Arch Pathol Lab Med, 2019, 143(12): 1492-1496.
10.	Leng PN, Wan Zain WZ, Mohammad Azmi MAF, et al. Carcinosarcoma: a rare and aggressive breast tumor in a young lady. Cureus, 2023, 15(4): e37003. doi: 10.7759/cureus.37003.
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12.	Cserni G, Quinn CM, Foschini MP, et al. Triple-negative breast cancer histological subtypes with a favourable prognosis. Cancers (Basel), 2021, 13(22): 5694. doi: 10.3390/cancers13225694.
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18.	Ong CT, Campbell BM, Thomas SM, et al. Metaplastic breast cancer treatment and outcomes in 2 500 patients: a retrospective analysis of a National Oncology Database. Ann Surg Oncol, 2018, 25(8): 2249-2260.
19.	Zhang J, Yang C, Lei C, et al. Survival outcomes after breast-conserving therapy compared with mastectomy for patients with early-stage metaplastic breast cancer: a population-based study of 2 412 patients. Breast, 2021, 58: 10-17.
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27.	Kennedy WR, Gabani P, Acharya S, et al. Clinical outcomes and patterns of care in the treatment of carcinosarcoma of the breast. Cancer Med, 2019, 8(4): 1379-1388.
28.	Haque W, Verma V, Naik N, et al. Metaplastic breast cancer: practice patterns, outcomes, and the role of radiotherapy. Ann Surg Oncol, 2018, 25(4): 928-936.
29.	Ryckman EM, Murphy TJ, Meschter SC, et al. AIRP best cases in radiologic-pathologic correlation: metaplastic squamous cell carcinoma of the breast. Radiographics, 2013, 33(7): 2019-2024.
30.	Hennessy BT, Giordano S, Broglio K, et al. Biphasic metaplastic sarcomatoid carcinoma of the breast. Ann Oncol, 2006, 17(4): 605-613.
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37.	Cimino-Mathews A, Verma S, Figueroa-Magalhaes MC, et al. A clinicopathologic analysis of 45 patients with metaplastic breast carcinoma. Am J Clin Pathol, 2016, 145(3): 365-372.
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40.	Lee H, Jung SY, Ro JY, et al. Metaplastic breast cancer: clinicopathological features and its prognosis. J Clin Pathol, 2012, 65(5): 441-446.
41.	Song Y, Liu X, Zhang G, et al. Unique clinicopathological features of metaplastic breast carcinoma compared with invasive ductal carcinoma and poor prognostic indicators. World J Surg Oncol, 2013, 11: 129. doi: 10.1186/1477-7819-11-129.
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43.	Wang S, Hu J, Zhang Y, et al. Presentation and survival by hormonal receptor status in metaplastic breast cancer: a propensity score-matched analysis. Breast, 2021, 60: 168-176.
44.	Mao J, Hu J, Zhang Y, et al. Single hormone receptor-positive metaplastic breast cancer: similar outcome as triple-negative subtype. Front Endocrinol (Lausanne), 2021, 12: 628939. doi: 10.3389/fendo.2021.628939.
45.	Wu SG, Yang SP, Zhang WW, et al. The longitudinal risk of mortality between invasive ductal carcinoma and metaplastic breast carcinoma. Sci Rep, 2020, 10(1): 22070. doi: 10.1038/s41598-020-79166-5.
46.	Abada E, Kim S, Dozier K, et al. Estrogen receptor status has no prognostic relevance in metaplastic breast carcinoma. Cancer Treat Res Commun, 2022, 33: 100630. doi: 10.1016/j.ctarc.2022.100630.
47.	Lei T, Pu T, Wei B, et al. Clinicopathologic characteristics of HER2-positive metaplastic squamous cell carcinoma of the breast. J Clin Pathol, 2022, 75(1): 18-23.
48.	Ross JS, Badve S, Wang K, et al. Genomic profiling of advanced-stage, metaplastic breast carcinoma by next-generation sequencing reveals frequent, targetable genomic abnormalities and potential new treatment options. Arch Pathol Lab Med, 2015, 139(5): 642-649.
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1. Aghajanzadeh M, Torabi H, Najafi B, et al. Intermammary breast cancer: a rare case of cancer with origin of breast cells in an unusual location. SAGE Open Med Case Rep, 2023, 11: 2050313X231154996. doi: 10.1177/2050313X231154996.
2. Reddy TP, Rosato RR, Li X, et al. A comprehensive overview of metaplastic breast cancer: clinical features and molecular aberrations. Breast Cancer Res, 2020, 22(1): 121. doi: 10.1186/s13058-020-01353-z.
3. Huvos AG, Lucas JC Jr, Foote FW Jr. Metaplastic breast carcinoma. Rare form of mammary cancer. N Y State J Med, 1973, 73(9): 1078-1082.
4. Fritz A, Percy C, Jack A, et al. International classification of diseases for oncology. Third Edition. Renouf Pub Co Ltd, 2000.
5. Sunil RL, Lan OE, Stuart JS, et al. WHO classification of tumours of the breast. Lyon: IARC Press, 2012.
6. Nagtegaal ID, Odze RD, Klimstra D, et al. The 2019 WHO classification of tumours of the digestive system. Histopathology, 2020, 76(2): 182-188.
7. Thapa B, Arobelidze S, Clark BA, et al. Metaplastic breast cancer: characteristics and survival outcomes. Cureus, 2022, 14(8): e28551. doi: 10.7759/cureus.28551.
8. McMurtry V, Cleary AS, Ruano AL, et al. Metaplastic breast carcinoma: clinicopathologic features and recurrence score results from a population-based database. Am J Clin Oncol, 2023, 46(12): 559-566.
9. McMullen ER, Zoumberos NA, Kleer CG. Metaplastic breast carcinoma: update on histopathology and molecular alterations. Arch Pathol Lab Med, 2019, 143(12): 1492-1496.
10. Leng PN, Wan Zain WZ, Mohammad Azmi MAF, et al. Carcinosarcoma: a rare and aggressive breast tumor in a young lady. Cureus, 2023, 15(4): e37003. doi: 10.7759/cureus.37003.
11. Qiu Y, Chen Y, Zhu L, et al. Differences of clinicopathological features between metaplastic breast carcinoma and nonspecific invasive breast carcinoma and prognostic profile of metaplastic breast carcinoma. Breast J, 2022, 2022: 2500594. doi: 10.1155/2022/2500594.
12. Cserni G, Quinn CM, Foschini MP, et al. Triple-negative breast cancer histological subtypes with a favourable prognosis. Cancers (Basel), 2021, 13(22): 5694. doi: 10.3390/cancers13225694.
13. Li Y, Zhang N, Zhang H, et al. Comparative prognostic analysis for triple-negative breast cancer with metaplastic and invasive ductal carcinoma. J Clin Pathol, 2019, 72(6): 418-424.
14. Li Y, Chen M, Pardini B, et al. The role of radiotherapy in metaplastic breast cancer: a propensity score-matched analysis of the SEER database. J Transl Med, 2019, 17(1): 318. doi: 10.1186/s12967-019-2069-y.
15. Hu Q, Chen WX, Zhong SL, et al. Current progress in the treatment of metaplastic breast carcinoma. Asian Pac J Cancer Prev, 2013, 14(11): 6221-6225.
16. Schroeder MC, Rastogi P, Geyer CE, et al. Early and locally advanced metaplastic breast cancer: presentation and survival by receptor status in Surveillance, Epidemiology, and End Results (SEER) 2010–2014. Oncologist, 2018, 23(4): 481-488.
17. Nelson RA, Guye ML, Luu T, et al. Survival outcomes of metaplastic breast cancer patients: results from a US population-based analysis. Ann Surg Oncol, 2015, 22(1): 24-31.
18. Ong CT, Campbell BM, Thomas SM, et al. Metaplastic breast cancer treatment and outcomes in 2 500 patients: a retrospective analysis of a National Oncology Database. Ann Surg Oncol, 2018, 25(8): 2249-2260.
19. Zhang J, Yang C, Lei C, et al. Survival outcomes after breast-conserving therapy compared with mastectomy for patients with early-stage metaplastic breast cancer: a population-based study of 2 412 patients. Breast, 2021, 58: 10-17.
20. Shah DR, Tseng WH, Martinez SR. Treatment options for metaplastic breast cancer. ISRN Oncol, 2012, 2012: 706162. doi: 10.5402/2012/706162.
21. Moreno AC, Lin YH, Bedrosian I, et al. Outcomes after treatment of metaplastic versus other breast cancer subtypes. J Cancer, 2020, 11(6): 1341-1350.
22. Tseng WH, Martinez SR. Metaplastic breast cancer: to radiate or not to radiate?. Ann Surg Oncol, 2011, 18(1): 94-103.
23. Erjan A, Almasri H, Abdel-Razeq H, et al. Metaplastic breast carcinoma: experience of a Tertiary Cancer Center in the Middle East. Cancer Control, 2021, 28: 10732748211004889. doi: 10.1177/10732748211004889.
24. He X, Ji J, Dong R, et al. Prognosis in different subtypes of metaplastic breast cancer: a population-based analysis. Breast Cancer Res Treat, 2019, 173(2): 329-341.
25. Zhang J, Wang XX, Lian JY, et al. Effect of postmastectomy radiotherapy on triple-negative breast cancer with T1-2 and 1-3 positive axillary lymph nodes: a population-based study using the SEER 18 database. Oncotarget, 2019, 10(50): 5245-5252.
26. Hu J, Tan J, Dong F, et al. The effect of post-mastectomy radiotherapy in patients with metaplastic breast cancer: a propensity score-matched analysis of the SEER database. Front Oncol, 2022, 11: 593121. doi: 10.1177/10732748211004889.
27. Kennedy WR, Gabani P, Acharya S, et al. Clinical outcomes and patterns of care in the treatment of carcinosarcoma of the breast. Cancer Med, 2019, 8(4): 1379-1388.
28. Haque W, Verma V, Naik N, et al. Metaplastic breast cancer: practice patterns, outcomes, and the role of radiotherapy. Ann Surg Oncol, 2018, 25(4): 928-936.
29. Ryckman EM, Murphy TJ, Meschter SC, et al. AIRP best cases in radiologic-pathologic correlation: metaplastic squamous cell carcinoma of the breast. Radiographics, 2013, 33(7): 2019-2024.
30. Hennessy BT, Giordano S, Broglio K, et al. Biphasic metaplastic sarcomatoid carcinoma of the breast. Ann Oncol, 2006, 17(4): 605-613.
31. Al-Hilli Z, Choong G, Keeney MG, et al. Metaplastic breast cancer has a poor response to neoadjuvant systemic therapy. Breast Cancer Res Treat, 2019, 176(3): 709-716.
32. Wong W, Brogi E, Reis-Filho JS, et al. Poor response to neoadjuvant chemotherapy in metaplastic breast carcinoma. NPJ Breast Cancer, 2021, 7(1): 96. doi: 10.1038/s41523-021-00302-z.
33. Abada E, Daaboul F, Ebare K, et al. Clinicopathologic characteristics and outcome descriptors of metaplastic breast carcinoma. Arch Pathol Lab Med, 2022, 146(3): 341-350.
34. Tan Y, Yang B, Chen Y, et al. Outcomes of metaplastic breast cancer versus triple-negative breast cancer: a propensity score matching analysis. World J Surg, 2023, 47(12): 3192-3202.
35. Esbah O, Turkoz FP, Turker I, et al. Metaplastic breast carcinoma: case series and review of the literature. Asian Pac J Cancer Prev, 2012, 13(9): 4645-4649.
36. Hu J, Lang R, Zhao W, et al. The mixed subtype has a worse prognosis than other histological subtypes: a retrospective analysis of 217 patients with metaplastic breast cancer. Breast Cancer Res Treat, 2023, 200(1): 23-36.
37. Cimino-Mathews A, Verma S, Figueroa-Magalhaes MC, et al. A clinicopathologic analysis of 45 patients with metaplastic breast carcinoma. Am J Clin Pathol, 2016, 145(3): 365-372.
38. Al Sayed AD, El Weshi AN, Tulbah AM, et al. Metaplastic carcinoma of the breast clinical presentation, treatment results and prognostic factors. Acta Oncol, 2006, 45(2): 188-195.
39. Takala S, Heikkilä P, Nevanlinna H, et al. Metaplastic carcinoma of the breast: prognosis and response to systemic treatment in metastatic disease. Breast J, 2019, 25(3): 418-424.
40. Lee H, Jung SY, Ro JY, et al. Metaplastic breast cancer: clinicopathological features and its prognosis. J Clin Pathol, 2012, 65(5): 441-446.
41. Song Y, Liu X, Zhang G, et al. Unique clinicopathological features of metaplastic breast carcinoma compared with invasive ductal carcinoma and poor prognostic indicators. World J Surg Oncol, 2013, 11: 129. doi: 10.1186/1477-7819-11-129.
42. Paul Wright G, Davis AT, Koehler TJ, et al. Hormone receptor status does not affect prognosis in metaplastic breast cancer: a population-based analysis with comparison to infiltrating ductal and lobular carcinomas. Ann Surg Oncol, 2014, 21(11): 3497-3503.
43. Wang S, Hu J, Zhang Y, et al. Presentation and survival by hormonal receptor status in metaplastic breast cancer: a propensity score-matched analysis. Breast, 2021, 60: 168-176.
44. Mao J, Hu J, Zhang Y, et al. Single hormone receptor-positive metaplastic breast cancer: similar outcome as triple-negative subtype. Front Endocrinol (Lausanne), 2021, 12: 628939. doi: 10.3389/fendo.2021.628939.
45. Wu SG, Yang SP, Zhang WW, et al. The longitudinal risk of mortality between invasive ductal carcinoma and metaplastic breast carcinoma. Sci Rep, 2020, 10(1): 22070. doi: 10.1038/s41598-020-79166-5.
46. Abada E, Kim S, Dozier K, et al. Estrogen receptor status has no prognostic relevance in metaplastic breast carcinoma. Cancer Treat Res Commun, 2022, 33: 100630. doi: 10.1016/j.ctarc.2022.100630.
47. Lei T, Pu T, Wei B, et al. Clinicopathologic characteristics of HER2-positive metaplastic squamous cell carcinoma of the breast. J Clin Pathol, 2022, 75(1): 18-23.
48. Ross JS, Badve S, Wang K, et al. Genomic profiling of advanced-stage, metaplastic breast carcinoma by next-generation sequencing reveals frequent, targetable genomic abnormalities and potential new treatment options. Arch Pathol Lab Med, 2015, 139(5): 642-649.
49. Kim I, Rajamanickam V, Bernard B, et al. A case series of metastatic metaplastic breast carcinoma treated with anti-PD-1 therapy. Front Oncol, 2021, 11: 635237. doi: 10.3389/fonc.2021.635237.
50. Moulder S, Helgason T, Janku F, et al. Inhibition of the phosphoinositide 3-kinase pathway for the treatment of patients with metastatic metaplastic breast cancer. Ann Oncol, 2015, 26(7): 1346-1352.
51. Zhang Y, Toy KA, Kleer CG. Metaplastic breast carcinomas are enriched in markers of tumor-initiating cells and epithelial to mesenchymal transition. Mod Pathol, 2012, 25(2): 178-184.
52. Leite C, Dias N, Oliveira D, et al. Metaplastic breast cancer with chondroid differentiation—case report and literature review. J Surg Case Rep, 2021, 2021(4): rjab113. doi: 10.1093/jscr/rjab113.
53. Hayes MJ, Thomas D, Emmons A, et al. Genetic changes of Wnt pathway genes are common events in metaplastic carcinomas of the breast. Clin Cancer Res, 2008, 14(13): 4038-4044.
54. Leibl S, Moinfar F. Metaplastic breast carcinomas are negative for Her-2 but frequently express EGFR (Her-1): potential relevance to adjuvant treatment with EGFR tyrosine kinase inhibitors?. J Clin Pathol, 2005, 58(7): 700-704.
55. Voutilainen S, Heikkilä P, Sampo M, et al. Expression of markers of stem cell characteristics, epithelial-mesenchymal transition, basal-like phenotype, proliferation, and androgen receptor in metaplastic breast cancer and their prognostic impact. Acta Oncol, 2021, 60(9): 1233-1239.
56. Cooper CL, Karim RZ, Selinger C, et al. Molecular alterations in metaplastic breast carcinoma. J Clin Pathol, 2013, 66(6): 522-528.
57. Zhou N, Liu C, Hou H, et al. Response to apatinib in chemotherapy-failed advanced spindle cell breast carcinoma. Oncotarget, 2016, 7(44): 72373-72379.
58. Corso G, Marabelli M, Calvello M, et al. Germline pathogenic variants in metaplastic breast cancer patients and the emerging role of the BRCA1 gene. Eur J Hum Genet, 2023, 31(11): 1275-1282.
59. Romero D. EMBRACing a new PARP inhibitor?. Nat Rev Clin Oncol, 2018, 15(11): 655. doi: 10.1038/s41571-018-0090-3.
60. Robson M, Im SA, Senkus E, et al. Olaparib for metastatic breast cancer in patients with a germline BRCA mutation. N Engl J Med, 2017, 377(6): 523-533.
61. Litton JK, Scoggins ME, Hess KR, et al. Neoadjuvant talazoparib for patients with operable breast cancer with a germline BRCA pathogenic variant. J Clin Oncol, 2020, 38(5): 388-394.
62. Dave B, Gonzalez DD, Liu ZB, et al. Role of RPL39 in metaplastic breast cancer. J Natl Cancer Inst, 2016, 109(6): djw292. doi: 10.1093/jnci/djw292.
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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Treatment progress of metaplastic breast cancer

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