Qingjian Tan,* Na Li,* Yan Wang, Tian Du, Gehao Liang, Zixuan Zhao, Jun Tang, Hao Wu

Department of Breast Cancer, State Key Laboratory of Oncology in South China, Guangdong Provincial Clinical Research Center for Cancer, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong Province, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Jun Tang, Email tangjun@sysucc.org.cn Hao Wu, Email wuhao1@sysucc.org.cn

Purpose: Metaplastic breast carcinoma (MpBC) is a rare and aggressive subtype of breast cancer that often shows poor response to conventional neoadjuvant chemotherapy (NAC). This study aimed to evaluate the efficacy of combining NAC with immune checkpoint inhibitors (ICIs) in MpBC patients.
Methods: We conducted a retrospective analysis of MpBC patients treated with NAC, with or without the addition of immunotherapy, at Sun Yat-sen university Cancer center between 2017 and 2024. We assessed clinical and pathological response to NAC in MpBC patients.
Results: 40 MpBC patients treated with NAC were identified, 33 patients treated with NAC alone, 7 patients treated with NAC and immunotherapy, 4 (10%) patients achieved pCR. Among the 33 patients treated with NAC alone, only 2 (6%) achieved pCR. In contrast, 7 patients received additional immunotherapy, and 3 started immunotherapy at the initiation of NAC, with 2 of these (67%) achieving pCR. Patients who received immunotherapy after disease progression on NAC showed varying degrees of tumor response, from stable disease (SD) to partial response (PR).
Conclusion: We observed a promising response on addition of immunotherapy to NAC among patients with MpBC, suggesting that immunotherapy may have great potential in the treatment of metaplastic breast carcinoma.

Keywords: metaplastic breast carcinoma, neoadjuvant chemotherapy, pathological complete response, immunotherapy