Metaplastic breast cancer: Prognosis and response to systemic therapy

Abstract

SummaryBackground: Metaplastic breast cancer is a rare disease with little information available to guide therapy. The goals of this study were to describe the patient characteristics, systemic therapies and clinical outcomes of all patients with primary metaplastic breast cancer treated at Mayo Clinic between 1976 and 1997.Patients and methods: Patients were identified through the medical index of Mayo Clinic. Clinical information was abstracted from the medical record of each patient. A literature search using MEDLINE and CANCERLIT for the years 1966-1997 was performed to identify all previously reported case series in the English language containing 10 or more patients.Results: Twenty-seven patients were identified with a median age at diagnosis of 59 years (range 39-90 years). The median tumor size was 3.4 cm (range 0.5-7.0 cm). One patient had metastatic disease at presentation. Twenty-three patients had information available on nodal status, estrogen receptor (ER) and progesterone receptor (PR) status. Twenty patients (87%) were node-negative and three patients (13%) were both ER and PR positive. Disease-free survival (DFS) and overall

Current Progress in the Treatment of Metaplastic Breast Carcinoma

“…Due to a rapidly growing and palpable large mass (≥ 5 cm) in MBC patients, MRM was the main surgical procedure in most series (Pitts et al, 1991;Gutman et al, 1995;Chao et al, 1999;Rayson et al, 1999;Al Sayed et al, 2006;Pezzi et al, 2007). However, BCS could not be precluded for appropriate MBC patients who had absolute or relative indications.…”

“…Sneige et al proposed a lumpectomy with wide margins or even a simple mastectomy relative to the tumor size (Sneige et al, 2001). Some cases with local recurrences had been successfully salvaged by surgery +/-radiotherapy and had a median survival of 47 months (Gutman et al, 1995;Rayson et al, 1999;Al sayed et al, 2006). Taking into account the large mass and poor prognosis, we choose MRM as an optimal surgical treatment, but BCS, lumpectomy, local excision with cancer-free margins cannot be precluded in some eligible patients.…”

“…Similarly, carcinosarcoma with malignant mesenchymal component had not clinical or pathological ALN involvement. Unlike IDC, ALN metastases in MBC patients were low risky and did not correlate with clinical outcome (Bauer et al, 1984;Oberman, 1987;Gutman et al, 1995;Rayson et al, 1999). It seems that blood transfer is the main route of transmission, not the lymphatic metastasis.…”

“…MBC normally manifests as a rapidly growing and palpable large mass (≥5 cm), indicating a high potential for distant metastases. It is frequently lymph node negative (Oberman, 1987;Pitts et al, 1991;Gutman et al, 1995;Chao et al, 1999;Rayson et al, 1999). MBC is an aggressive disease which is more likely to be negative for estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) (Wargotz and Norris, 1989;Bae et al, 2011).…”

“…It is usually treated with mastectomy, radiotherapy and chemotherapy. The prognosis is worse (Rayson et al, 1999), so early detection and treatment is the key factor to improve the cure rate. Although there are several reports, knowledge about MBC is still limited.…”