Survival Rates Similar Among Patients With Metaplastic Or Ductal Triple
|The following article is part of conference coverage from the 17th St. Gallen International Breast Cancer Symposium, which is being held virtually from March 7-21, 2021. The team at Cancer Therapy Advisor will be reporting on the latest research conducted by leading experts in breast cancer. Check back for more from the 17th St. Gallen International Breast Cancer Symposium.|
Similar rates of disease-free and overall survival were seen in a study of women with metaplastic and ductal triple-negative breast cancer , according to an Italian study presented at the 17th St. Gallen International Breast Cancer Conference.
According to the study poster, metaplastic breast carcinoma accounts for 0.2% to 0.5% of all breast cancers and has an aggressive clinical evolution. In this study, Antonia Girardi, of the division of breast surgery at the European Institute of Oncology IRCCS, in Milan, Italy, and colleagues evaluated if metaplastic breast cancer had a clinical evolution, treatment, overall survival, and prognosis that matched a population of patients with TNBC.
The retrospective study included data from all cases of metaplastic breast cancer in the institutional database at the European Institute of Oncology in Milan. All cases diagnosed between 1998 and 2019 were included in the study.
The majority of metaplastic cases were triple negative . Additionally, most cases were grade 3 , pN0 , with peritumoral vascular invasion , and with high levels of Ki-67 .
Can Stage 4 Breast Cancer Go Into Remission
Stage 4 breast cancer can go into remission, meaning that it isnt detected in imaging or other tests. Pathological complete remission indicates a lack of cancer cells in tissues removed after surgery or biopsy.
But its rare to take tissue samples while treating stage 4 breast cancer. This could mean that although treatment has been effective, it hasnt completely destroyed the cancer.
Advances in stage 4 breast cancer treatments are helping to increase the length of remission.
Metaplastic Breast Cancer: Treatment And Prognosis By Molecular Subtype
The role of radiotherapy in prognosis of metaplastic breast cancer remains controversial.
The effect of molecular subtype on treatment and prognosis is unclear.
Our study took the variables with difference in multivariate model into adjusted kaplanMeier analysis.
Adjusted model showed that triple-negative but not HER2-positive or HR-positive patients receiving RT had a superior prognosis .
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Family History Of Breast Cancer
A positive family history of breast cancer is the most widely recognized risk factor for breast cancer. The lifetime risk is up to 4 times higher if a mother and sister are affected, and it is about 5 times greater in women who have two or more first-degree relatives with breast cancer. The risk is also greater among women with breast cancer in a single first-degree relative, particularly if the relative was diagnosed at an early age .
Despite a history indicating increased risk, many of these families have normal results on genetic testing. However, identification of additional genetic variants associated with increased risk may prove valuable. Michailidou et al conducted a controlled genome-wide association study of breast cancer that included 122,977 cases of European ancestry and 14,068 cases of East Asian ancestry, and identified 65 new loci associated with overall breast cancer risk. A GWAS by Milne et al identified 10 variants at 9 new loci that are associated with risk of estrogen receptornegative breast cancer.
A family history of ovarian cancer in a first-degree relative, especially if the disease occurred at an early age , has been associated with a doubling of breast cancer risk. This often reflects inheritance of a pathogenic mutation in the BRCA1 or BRCA2 gene.
The family history characteristics that suggest increased risk of cancer are summarized as follows:
- Ontario Family History Assessment Tool
Direct-to-consumer genetic testing
Triple Negative Metaplastic Breast Carcinomas Tend To Have A Higher
However, what is interesting about metaplastic breast cancer is that the outlook and prognosis with respect to triple-negative status is contrary to the norm.
Recent studies have shown, contrary to a generally accepted view, that a non-triple-negative metaplastic breast carcinoma actually has a poorer prognosis in comparison with the triple-negative metaplastic breast carcinoma.
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Rna And Tcr Sequencing
Comparison of RNA sequencing did not demonstrate significant differences between metaplastic and non-metaplastic cases in multiple genes of interest, but did note multiple outlier genes, with an arbitrary cutoff of a modified z-score > 3 in 2 or more metaplastic cases selected to identify possible outliers: SOX8, CIC, COL9A3, ZFAND1, UBE2W, C2orf40, ENY2, RBM39, TGS1, DPY19L4, CLEC18A, ACAN, SLC25A32, VIRMA, IGF2, NOTUM, WWP2, NPIPB11, UPK1B, GABPB1, NR4A1, SLC25A42, FBXO25. RNA expression in pathways of interest in MBC are further presented in Figures 1, 2, 4, 5 and 8.
Figure 8 RNA Heat Map. RNA expression heatmaps with modified z-scores of expression vs non-metaplastics represented for each patient for 3 molecular pathways of interest in metaplastic breast cancer, RAS-MRK-ERK pathway, PI3K-AKT-mTOR pathway, TP53 pathway.
TCR sequencing did not find significant changes in T-cell diversity by richness or clonality at baseline or during treatment between metaplastics and non-metaplastics. Evaluating the clonotype structure, metaplastics as a group vs non-metaplastics did not have significant differences in the amounts of higher frequency or lower frequency clones . However, Case 2 and Case 4 had a greater proportion of high-prevalence clones compared to other cases at baseline with Case 2 being a responder and Case 4 being a non-responder.
Symptoms Of Metastatic Breast Cancer
The symptoms of stage 4 breast cancer depend on the location of the cancer and where it has spread in your body.
- If breast cancer has spread to your bones, you may notice a sudden new bone pain. Breast cancer most commonly spreads to your ribs, spine, pelvis, or arm and leg bones.
- If it has spread to your brain, you may experience headaches, vision or speech changes, or memory problems.
- Breast cancer that has spread to your lungs or liver usually causes no symptoms.
The main treatments for stage 4 breast cancer are targeted drug therapies that destroy cancer cells wherever they are in your body.
These treatments may include:
- hormone therapy, which stops or slows the growth of tumors by preventing your body from producing hormones or interfering with the effect of hormones on breast cancer cells
- chemotherapy, where drugs given orally or through an IV travel through your bloodstream to fight cancer cells
- immunotherapy, which uses drugs that stimulate your immune system to destroy cancer cells
- a combination of these therapies
The following are the common treatment options for different types of stage 4 breast cancer.
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Reproductive Factors And Steroid Hormones
Late age at first pregnancy, nulliparity, early onset of menses, and late age of menopause have all been consistently associated with an increased risk of breast cancer. Prolonged exposure to elevated levels of sex hormones has long been postulated as a risk factor for developing breast cancer, explaining the association between breast cancer and reproductive behaviors.
Clinical trials of secondary prevention in women with breast cancer have demonstrated the protective effect of selective estrogen receptor modulators and aromatase inhibitors on recurrence and the development of contralateral breast cancers. Use of SERMs in women at increased risk for breast cancer has prevented invasive ER-positive cancers. These data support estradiol and its receptor as a primary target for risk reduction but do not establish that circulating hormone levels predict increase risk.
A number of epidemiologic and pooled studies support an elevated risk of breast cancer among women with high estradiol levels. The Endogenous Hormones and Breast Cancer Collaborative Group reported a relative risk of 2.58 among women in the top quintile of estradiol levels.
A meta-analysis by the Collaborative Group on Hormonal Factors in Breast Cancer of 58 international studies that included 143,887 postmenopausal women with invasive breast cancer and 424,972 without breast cancer concluded the following about menopausal HRT and breast cancer :
Triple Negative And Non Triple Negative Status
Metaplastic breast carcinomas are frequently negative for the HER2 protein and frequently negative for ER and PR receptors as well. So, medics call cancers that are either lacking or very low in all three types of receptors triple negative.
Triple-negative cancers in general form a potential subtype of breast carcinoma as the cancer cells behave in an aggressive fashion with a somewhat distinctive patterns of metastasis .
Sadly, triple negative tumors often seem initially receptive to chemical therapy, but are also prone to early relapse.
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The Survival Rate For Metaplastic Breast Cancers Is About The Same As For Other Nos Breast Cancers Of Similar Stage And Grade
So, generally speaking, metaplastic carcinoma of the breast has poor prognostic indicators. BUT researchers think that the survival rate is no different from other breast cancers of a similar stage with the same aggressive multi-modal treatments.
One brighter spot for metaplastic breast carcinoma is that some tumors do show an increase in EGFR expression, which does provide for some specifically targeted chemical interventions.
Molecular analysis for possible genetic alterations in the EGFR may be necessary. So there is a good chance that women fighting metaplastic breast cancer might benefit from treatment with protein kinase inhibitors. These include Gefitinib and Cetuximab .
What Is A 5
A relative survival rate compares women with the same type and stage of breast cancer to women in the overall population. For example, if the 5-year relative survival rate for a specific stage of breast cancer is 90%, it means that women who have that cancer are, on average, about 90% as likely as women who dont have that cancer to live for at least 5 years after being diagnosed.
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Metaplastic Breast Cancers May Have A Carcinosarcoma
If the metaplastic breast carcinoma tends to have a carcinosarcoma-like differentiation, the treatment and prognosis may be different.
Sarcomas tend to have different metastatic pathways than carcinoma, and chemotherapy will tend to be oriented towards the sarcomatous component .
Axillary lymph node involvement is actually quite rare with carcinosarcoma. However, the rate of lymph node involvement in metaplastic breast carcinomas ranges up to 30%.
The overall 5-year survival rate for breast carcinosarcoma is estimated at around 40%, and most likely influenced by:-
- type and grade of the mesenchymal component in particular.
Metaplastic Breast Cancer Treatment
Metaplastic breast cancer makes up less than 1% of all breast cancer diagnoses. Because it is so rare, there have been few clinical trials dedicated to the disease. Based on current guidelines, it should be treated like other breast cancers at the same stage and with the same features.
Most metaplastic breast cancers have triple-negative receptor status. These breast cancers do not have high levels of the estrogen receptor, progesterone receptor, and HER2 gene/protein. Drugs that target these features of cancer cells do not work well against triple-negative cancers. Other treatment strategies are needed.
If a patient is diagnosed before the cancer has spread beyond the breast and surrounding lymph nodes, treatment usually starts with chemotherapy, possibly in combination with immunotherapy, to shrink the tumor. This treatment is followed by surgery and potentially radiation therapy.
If the cancer has spread beyond the breast and surrounding lymph nodes, it is usually treated with chemotherapy or other cancer drugs, either alone or in combination. Radiation may be used to reduce pain caused by a tumor mass.
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Prognosis And Recurrence Rates
The rate of local recurrence is variable of course, but researchers estimate it to be around 30%. Studies also estimate the five year disease free rate to be around 40%. Furthermore, estimates for the overall five year survival for metaplastic breast tends to at around 50% to 65%, .
The stage of the cancer also has a bearing on survival rates. So if the cancer is at Stage III or above the survival rate is just over 50%.
Survival rates for stage I and II metaplastic breast cancers are very good. Metaplastic breast tumors tend to be of medium size, on average about 4 to 5 cm. Curiously, unlike other tumors, the size of tumor has little bearing on prognosis.
The same holds true for nodal status, menopausal status, histologic subtype and a womans age. The extent of surgery and the use of adjuvant therapy likewise tends to have no generalizable impact on recurrence and survival. However, there is some suggestion that patients receiving a complete surgical resection, where available, tend to do better.
What Is Metaplastic Carcinoma Of The Breast
Metaplastic carcinoma of the breast is a subtype of invasive breast cancer. Metaplastic breast cancer is a very rare form of breast cancer, accounting for less than 1% of cases. Like invasive , metaplastic carcinoma starts in the milk ducts. Since it is invasive, it has grown through the wall of the milk duct into other breast tissues or beyond the breast.
Doctors call it metaplastic because of the way the cells look under a microscope. Instead of looking like ductal cells, metaplastic tumor cells look very abnormal. In fact, they look more like other tissues in the breast, such as connective tissue. This has lead scientists to believe the ductal cells went through some kind of unexplained changeor metaplasia.
Because the cells look so different, metaplastic breast cancer can be hard to diagnose. If your results suggest this cancer, consider getting a second opinion. You can do this by asking your doctor to send your biopsy specimen slides to a different pathologist. Consider sending the slides to a cancer center with experience diagnosing metaplastic breast and other rare breast cancers.
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A Case Series Of Metastatic Metaplastic Breast Carcinoma Treated With Anti
- 1Earle A. Chiles Research Institute, Providence Cancer Institute, Portland, OR, United States
- 2Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA, United States
Metaplastic breast cancer is a rare and often chemo-refractory subtype of breast cancer with poor prognosis and limited treatment options. Recent studies have reported overexpression of programmed death ligand 1 in metaplastic breast cancers, and there are several reports of anti-PD-1/L1 being potentially active in this disease. In this case series, we present 5 patients with metastatic metaplastic breast cancer treated with anti-PD-1-based therapy at a single center, with 3 of 5 cases demonstrating a response to therapy, and one of the responding cases being a metaplastic lobular carcinoma with low-level hormone receptor expression. Cases were evaluated for PD-L1 expression, tumor infiltrating lymphocytes , DNA mutations, RNA sequencing, and T-cell receptor sequencing. Duration of the response in these cases was limited, in contrast to the more durable responses noted in other recently published reports.
Metaplastic Carcinoma Of The Breast
Metaplastic carcinoma of the breast
Support and advocacy groups can help you connect with other patients and families, and they can provide valuable services. Many develop patient-centered information and are the driving force behind research for better treatments and possible cures. They can direct you to research, resources, and services. Many organizations also have experts who serve as medical advisors or provide lists of doctors/clinics. Visit the groups website or contact them to learn about the services they offer. Inclusion on this list is not an endorsement by GARD.
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Triple Negative Breast Cancer
With this type of breast cancer, the breast cancer cells dont have ER+ or PR+ receptors. They dont overproduce the HER2 protein, so hormone therapy isnt very effective.
Instead, triple negative stage 4 breast cancer is usually treated with chemotherapy. Radiation therapy may also be an option, depending on the site of metastasis.
Factors Influencing Metastatic Breast Cancer Prognosis
There are several factors that can impact the prognosis of metastatic breast cancer, these include:
- Hormone receptors on cancer cells
- The type of tissue involved
- The number of tumors/extent of metastasis
- A persons overall attitude and outlook on the prognosis
Of course, no factors can accurately predict the exact prognosis for a person with metastatic breast cancer. These statistics are based on many clinical research studies, looking at survival rates for people diagnosed with breast cancer at all stages. But the prognosis of each person is different, regardless of what the statistics indicate.
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Metaplastic Breast Cancer Staging And Treatment
Treatment of metaplastic breast cancer is similar to that of more common types of breast cancer, and you can expect to receive some combination of both local therapy and systemic therapy.
Local therapy is aimed at preventing the cancer from coming back in the breast. Local therapy includes surgery , and may include radiation.
Systemic therapy is used to prevent the disease from coming back or spreading to another part of the body. This may include endocrine therapy, chemotherapy, and therapy that targets the HER2 protein. Sometimes different types of treatment are used together to achieve the best result.Your treatment plan will be based on the features of the tumor and the stage of the disease . Your oncology team will recommend a treatment plan based on what is known about metaplastic breast cancer in general and tailored specifically to your disease.
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What Is The Relative Survival Rate For Breast Cancer
A relative survival rate compares women with the same type and stage of breast cancer to women in the overall population. For example, if the 5-year relative survival rate for a specific stage of breast cancer is 90%, it means that women who have that cancer are, on average, about 90% as likely as women who dont have that cancer to live for
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