Clinical and Pathological Features of Early-Stage Metaplastic Carcinoma and Associated Patient Outcomes

Metaplastic breast carcinoma (MpBC) is an aggressive subtype of breast cancer that is usually resistant to chemotherapy. Few studies have analyzed the role of immunotherapy and other treatments in early stage MpBC. We identified clinicopathological and sociodemographic factors associated with treatment response and recurrence of disease among patients with nonmetastatic MpBC within 2 hospital systems.

A retrospective study was performed to evaluate female patients diagnosed with Stage I to Stage III MpBC within a safety-net hospital and private cancer center from January 2013 to October 2024.

We identified 54 patients with MpBC with a mean age of diagnosis of 55.2 years. There were 14 (25.95%) White, 26 (48.1%) Black, and 10 (18.5%) Hispanic patients. Thirteen (24.1%) patients were uninsured at the time of diagnosis. In total, 49 (90.7%) patients received chemotherapy and 19 (35.2%) received immunotherapy. Eight (14.8%) patients experienced MpBC recurrence at the time of this review. Patients with squamous features (P = .04) and Ki-67 ≥ 51% (P = .02) on histology were more likely to have a recurrence of disease. Patients with squamous histology (P = .02) were more likely to have greater residual cancer burden after neoadjuvant therapy. Treatment with immunotherapy, such as PD-L1 inhibitors, in addition to chemotherapy did not reduce disease recurrence.

MpBC remains an aggressive and treatment-resistant form of breast cancer. In our cohort of early-stage cases, the addition of immunotherapy to chemotherapy did not reduce the recurrence of disease. Additionally, treatment response and resistance may vary among the various histologic subtypes of MpBC.