Database Study Finds Similar Survival With Neoadjuvant Chemo-Immunotherapy in Metaplastic Breast Cancer

A retrospective National Cancer Database cohort study compared treatment outcomes in 4,953 patients with stage I–III triple-negative metaplastic breast cancer diagnosed from 2010 to 2022. Neoadjuvant chemo-immunotherapy was not associated with significantly different overall survival from upfront surgery and was linked to higher odds of pathologic complete response than neoadjuvant chemotherapy alone.

Cohort included 4,953 patients with stage I–III triple-negative disease.
NACIO and upfront surgery had no significant OS difference.
NACIO had higher odds of pCR than chemotherapy alone.
Retrospective design and baseline differences limit interpretation.

Metaplastic breast carcinoma is a rare, aggressive breast cancer subtype, and the optimal treatment sequence is uncertain. Researchers retrospectively analyzed National Cancer Database records for 4,953 patients with stage I–III triple-negative disease diagnosed between 2010 and 2022: 3,429 had upfront surgery, 1,232 received neoadjuvant chemotherapy (NAC), and 292 received neoadjuvant chemo-immunotherapy (NACIO). Outcomes included overall survival (OS), pathologic complete response (pCR), and breast conservation.

OS did not differ significantly between NACIO and upfront surgery (hazard ratio 0.80, 95% CI 0.51–1.27; p=0.3). Compared with NAC, NACIO was associated with higher odds of pCR (odds ratio 1.62, 95% CI 1.11–2.38; p=0.013). Breast conservation rates also did not differ significantly between NACIO and surgery-first groups. NAC alone was associated with higher mortality than upfront surgery (HR 1.37, 95% CI 1.21–1.56) and lower odds of breast-conserving surgery (OR 0.73, 95% CI 0.63–0.84).

The findings suggest NACIO may warrant prospective study in this population, but they do not establish equivalence or a survival benefit. Treatment groups differed in baseline stage, and residual confounding is possible in this retrospective database analysis.

In practice

For patients with stage I–III triple-negative metaplastic breast cancer, this retrospective database analysis found no statistically significant overall-survival difference between neoadjuvant chemo-immunotherapy and upfront surgery, and higher odds of pathologic complete response with chemo-immunotherapy than with neoadjuvant chemotherapy alone. These findings may inform discussion of treatment strategies and support prospective evaluation, but they do not establish that the approaches are equivalent or that chemo-immunotherapy improves survival. Baseline stage differences and residual confounding limit applicability; the study does not justify changing practice on its own.

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Source

Annals of Surgical Oncology: Neoadjuvant Chemo-Immunotherapy Yields Survival Comparable to Upfront Surgery in Metaplastic Breast Cancer: A National Cancer Database Analysis ↗

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