Neoadjuvant Versus Adjuvant Therapy for Metaplastic Breast Cancer: Insights from the National Cancer Database-Is...

Area of Science:

• Oncology
• Clinical Research
• Cancer Treatment

Background:

• Metaplastic breast cancer (MtBC) is a rare, aggressive subtype with poor treatment response.
• Large national cohort analysis is needed to compare treatment strategies and survival outcomes for MtBC.

Purpose of the Study:

• To compare treatment strategies and survival outcomes in metaplastic breast cancer (MtBC).
• To evaluate the impact of chemotherapy sequence (neoadjuvant vs. adjuvant) on clinical characteristics and survival in MtBC patients.

Main Methods:

• Analysis of a large national cohort of adult female patients diagnosed with MtBC (2006-2021).
• Grouping patients by chemotherapy sequence: neoadjuvant versus adjuvant.
• Evaluation of clinical characteristics, treatment modalities, and survival outcomes using multivariable analysis.

Main Results:

• Adjuvant chemotherapy was associated with improved overall survival (HR 0.65; P < 0.001) compared to neoadjuvant therapy (80.7% vs. 66.7% 5-year OS).
• Neoadjuvant therapy use increased over time and was more common in younger patients with advanced stages.
• Mastectomy, radiation, higher income, and immunotherapy were linked to better outcomes, while older age, nodal involvement, comorbidities, and lymphovascular invasion correlated with higher mortality.

Conclusions:

• Adjuvant chemotherapy and aggressive local treatments are associated with improved survival in MtBC.
• A tailored approach with upfront surgery followed by adjuvant therapy may be optimal for operable MtBC.
• Increasing neoadjuvant chemotherapy use and immunotherapy integration show promising survival trends, warranting further investigation.