Metastatic Male Breast Cancer Research Articles

Clinicopathological analysis of 38 male patients diagnosed with breast cancer.

Male breast cancer (MBC) accounts for one percent of all breast cancers. Due to the lack of awareness and routine screening programs, most patients present with systemic disease at the time of diagnosis with low overall survival. This study aims to investigate the prognostic factors of male breast cancer and its correlation with established prognostic parameters and patient outcomes. Thirty-eight male breast cancer patients are identified from the MKA Breast Cancer Clinic database, and their corresponding clinical and pathological characteristics are obtained. Cut-off values of 1% and 10% are applied to further classify ER and PR results. Older men are more likely to develop MBC than younger men and are more likely to have spread to axillary lymph nodes. Invasive ductal carcinoma is a more common histologic type in MBC. All the tested patients have ER and PR positivity. Distant metastasis developed in 17/38 (44.7%) patients. Bone metastasis is seen commonly in metastatic MBC. According to our cohort, MBC is seen in older males, presents in later stages, and shows hormone receptor positivity and a tendency to bone involvement. MBC is a heterogenous but distinct biological entity requiring a specific clinical and pathological approach.

Analysis of the distinct features of metastasis male breast cancer and its effect on overall survival based on the SEER database compared with female breast cancer.

Male breast cancer (MBC) is a rare disease and differs from female breast cancer (FBC) in clinicopathological and immune tissue types. Given the limited research on MBC due to its rarity, an understanding of the shared and distinct features of MBC and FBC is vital for formulating efficacious treatment strategies. Data of patients diagnosed with metastatic breast cancer in the Surveillance, Epidemiology, and End Results (SEER) database from 2012 to 2017 were analysed. Chi-square test was used to compare clinicopathological characteristics between male and female patients. Kaplan-Meier analysis was utilized to compare differences in overall survival (OS). A total of 2,858 patients with MBC were studied, 134 of whom had distant metastasis. Compared with 8,698 patients with metastatic FBC, a higher proportion of metastatic MBC patients had tumors located in the center of the breast, received surgical treatment, and had bone + lung metastasis. Survival analysis revealed no difference in OS between metastatic MBC and FBC patients (P=0.27), but there was a significant difference in OS between metastatic and nonmetastatic MBC (P=0.004). Compared with metastatic FBC, MBC patients with bone metastasis alone, lung metastasis alone, liver metastasis alone, and bone + lung metastasis also had worse prognosis (P=0.021, 0.019, 0.024, 0.011, respectively). Metastatic MBC has unique clinicopathological disease features and patterns of metastasis. No significant difference between the survival of metastatic MBC and FBC patients was observed. Distant metastasis was an independent risk factor impacting the prognosis of MBC patients.

Outcomes of the patients with metastatic male breast cancer.

The goal of this research is to investigate the clinical characteristics and prognosis of men with metastatic breast cancer (mMBC). A retrospective analysis of the data of 28 patients was conducted. Kaplan-Meier and Cox regression analyses were used to assess overall survival (OS) and prognostic variables. At the time of diagnosis, the median age was 57 years (range 26-86). The most prevalent pathological subtype was invasive ductal carcinoma (92.6%). HER2 positivity was 21.6% in patients, with estrogen and progesterone receptor positivity at 96.4% and 71.4%, respectively. Bone-75%, lung-39.3%, brain-21.4%, and adrenal gland-10.7% were the most prevalent metastatic sites. Trastuzumab-based chemotherapy was given to six patients. During the study period, 14 patients (or half) died. All patients had a median OS of 42.6 months (range: 21.6-63.7). The OS rates after 1, 3, and 5 years were 95.7%, 54.2%, and 36.6%, respectively. The number of metastatic locations (P = 0.045), brain metastasis (P = 0.033), and a history of regular alcohol intake (P = 0.008) were all shown to be statistically significant factors affecting OS in univariate analysis. However, multivariate analysis did not support the findings. In addition, we discovered that trastuzumab-based therapy and de-novo metastatic disease had no effect on OS for mMBC. The data on mMBC is restricted because of its rarity. The prognosis of mMBC was shown to be poor in this investigation. Despite the small number of patients, we discovered that in univariate analysis, having brain metastases, the number of metastatic locations, and a history of alcohol intake may be prognostic factors.

Rare oncological metastasis; Colorectal and male breast cancer

In this report, we describe three cases of rare oncologic metastases. The first patient was a 73-year-old male, diagnosed with metastatic male breast cancer after radiological investigation of suspected renal cell carcinoma. The other two male patients, a 69 and 73-yearold, were diagnosed with colon adenocarcinoma; suspected to be a second primary prostate carcinoma following Positron Emission Tomography-Computer Tomography (PET-CT). This suspicion was ruled out by prostatectomy and histopathological investigations, which instead found adenocarcinoma of colonic origin. Keywords: rare metastasis; colon cancer; male breast cancer; second primary; adenocarcinoma

ASO Author Reflection: Trimodality Therapy Offers Survival Advantage in Metastatic Male Breast Cancer.

ASO Author Reflection: Trimodality Therapy Offers Survival Advantage in Metastatic Male Breast Cancer.

An updated review of epidemiology, risk factors, and management of male breast cancer.

Unlike female breast cancer, male breast cancer (MBC) is rare and not very well understood. Prospective data in the management of MBC are lacking and majority of treatment strategies are adopted from the established guidelines for breast cancer in women. The understanding of biology, clinical presentation, genetics, and management of MBC is evolving but there still remains a large knowledge gap due to the rarity of this disease. Older age, high estradiol levels, klinefelter syndrome, radiation exposure, gynecomastia, family history of breast cancer, BRCA2 and BRCA1 mutation are some of the known risk factors for MBC. Routine screening mammography is not recommended for asymptomatic men. Diagnostic mammogram with or without ultrasound should be considered if there is a suspicion for breast mass. Majority of men with early-stage breast cancer undergo mastectomy whereas breast conserving surgery(BCS) with sentinel lymph node biopsy (SLNB) remains an alternative option in selected cases. Since the majority of MBC are hormone receptor positive (HR+), adjuvant hormonal therapy is required. Tamoxifen for a total of 5 to 10years is the mainstay adjuvant hormonal therapy. The role of neoadjuvant and adjuvant chemotherapy for early-stage breast cancer is uncertain and not commonly used. The role of gene recurrence scores like oncotype Dx and mammaprint is evolving and can be used as an aid for adjuvant chemotherapy. Majority of metastatic MBC are treated with hormonal therapy with either tamoxifen, gonadotropin-releasing hormone agonist (GnRH) with aromatase inhibitors (AI), or fulvestrant. Chemotherapy is reserved for patients with visceral crisis or rapidly growing tumors.

Abstract PS14-25: Outcomes of metastatic male breast cancer

Abstract Background: Breast cancer is rare in men. The prognosis of male breast cancer (MBC) is poor than female breast cancer. The study aims to evaluate the clinical features and prognosis in metastatic male breast cancer (mMBC). Method: The data of 28 patients were retrospectively reviewed. The clinical and histopathological features of the patients were recorded. Overall survival (OS) and prognostic factors evaluated with Kaplan-Meier analysis and Cox-regression analysis. Results: The median follow-up period was 55.1 months (range, 6.6-205.6). The median age at diagnosis was 57 years (range, 26-86). Seven (27%) of the patients were de-novo metastatic. Invasive ductal carcinoma (92.6%) was the most common pathological subtype. The ratio of HER2 positivity in patients was 21.6%, and estrogen and progesterone receptor's positivity were 96.4% and 71.4%, respectively. The most common metastatic locations of disease were bone-75%, lung-39.3%, brain-21.4%, and surrenal-10.7%. Six of the patients received trastuzumab-based chemotherapy. A total of 14 (50%) patients deceased during the study period. The median OS was 42.6±10.7 months (range, 21.6-63.7) for all patients. One-, three- and five-years overall survival ratios were 95.7%, 54.2%, and 36.6%, respectively. In univariate analysis, Brain metastasis (p=0.033), the number of metastatic sites (p=0.045), and the history of regular alcohol consumption (p=0.008) were a statistically significant factor on OS. However, the results were not confirmed in multivariate analysis. Also, we found that trastuzumab-based treatment and de-novo metastasis were not affecting on OS in mMBC. Conclusions: Due to the rarity, the data of mMBC is limited. In this study, we observed that the prognosis of mMBC was poor. Despite the low number of patients, we detected that having brain metastasis, the number of metastatic sites, and history of alcohol consumption may be a prognostic factor in univariate analysis. Citation Format: Izzet Dogan, Nijat Khanmammadov, Adnan Aydıner, Pınar Saip. Outcomes of metastatic male breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS14-25.

Metastatic male breast cancer found from bone marrow trephine

Metastatic male breast cancer found from bone marrow trephine

Metastasis pattern and prognosis of male breast cancer patients in US: a population-based study from SEER database.

Background:The aims of this study were to analyze the metastasis pattern and prognosis of male breast cancer (MBC) and compare it with female breast cancer (FBC), and to determine the independent factors affecting the prognosis of MBC patients.Methods:Metastatic MBC diagnosed in the Surveillance, Epidemiology and End results (SEER) database from 2010 to 2015 were selected. Chi-squared test was used to compare clinicopathological characteristics. Survival differences were compared by Kaplan–Meier analysis. Cox proportional hazard model was used to determine the prognostic factors affecting overall survival.Results:A total of 2754 MBC patients were identified, of which 196 had distant metastasis. Compared with nonmetastatic MBC, metastatic MBC patients had a higher proportion of <60 years old and grade III–IV, and were more likely to receive chemotherapy and radiotherapy, while the proportion of surgery, central portion of the breast, and Her2–/HR+ was lower. Compared with metastatic FBC, metastatic MBC patients had a higher proportion of ⩾60 years old, central portion of the breast, surgery, simultaneous bone and lung metastasis, while the proportion of Her2+/HR–, triple negative, liver metastasis only, and simultaneous bone and liver metastasis was lower. MBC patients with lung alone, bone alone, and simultaneous lung and bone metastasis had a higher hazard ratio (2.41; 3.06; 2.52; p < 0.0001) compared with nonmetastatic patients.Conclusions:Compared with nonmetastatic MBC patients, metastatic MBC patients had unique clinicopathological features, and were also different from metastatic FBC patients. However, there was no difference in prognosis between metastatic MBC and FBC patients. Distant metastasis was an independent risk factor for the prognosis of MBC patients.

Metastatic male accessory breast cancer mimicking metastasis of concurrent renal cell carcinoma

Metastatic male accessory breast cancer mimicking metastasis of concurrent renal cell carcinoma

Metastatic male breast cancer

Breast cancer of female is common but rare in male. It is diagnosed in advanced stage due to  the limited amount of breast tissue and lack of awareness. Most cases occur over the age of 60  years. Male breast cancer is treated like female breast cancer. The outcome of the disease is  worse, 5-4 year’s survival in about 40% cases.Mediscope Vol. 2, No. 1: 2015, Pages 36-38

Androgen receptor and antiandrogen therapy in male breast cancer

Cancers arising in the male breast are uncommon. Male breast cancer is a hormone-driven disease that often expresses the estrogen receptor, and antiestrogen therapy represents the mainstay of treatment. Paradoxically, the advent of a wave of antiestrogens eclipsed the therapeutic potential of alternative therapeutic options. At the beginning of the hormonal therapy era the administration of antiandrogens to metastatic male breast cancer patients was proposed. Ever since the use of these compounds has largely been neglected. A therapeutic role for antiandrogens has been envisioned again in recent years. First, molecular characterization efforts pointed to the androgen receptor as a potential therapeutic target. Second, the development of aromatase inhibitors unexpectedly raised the need for neutralizing androgens in order to tackle endocrine feedback mechanisms responsible for acquired resistance. We herein provide an overview of molecular studies where the androgen receptor was investigated at the genomic, transcriptomic or phenotypic level. We then discuss androgens in the context of the endocrine networks nourishing male breast cancer. Finally, clinical evidence on antiandrogens is summarized along with strategies should be implemented to improve the medical management of these patients.

Role of gonadotropin-releasing hormone analogues in metastatic male breast cancer: results from a pooled analysis.

BackgroundMale breast cancer is a rare malignancy. Despite the lack of prospectively generated data from trials in either the adjuvant or metastatic setting, patients are commonly treated with hormone therapies. Much controversy exists over the use of gonadotropin-releasing hormone analogues in metastatic male breast cancer patients. We conducted this study to provide more concrete ground on the use of gonadotropin-releasing hormone analogues in this setting.MethodsWe herein present results from a pooled analysis including 60 metastatic male breast cancer patients treated with either an aromatase inhibitor or cyproterone acetate as a monotherapy (23 patients) or combined with a gonadotropin-releasing hormone analogue (37 patients).ResultsOverall response rate was 43.5 % in patients treated with monotherapy and 51.3 % with combination therapy (p = 0.6). Survival outcomes favored combination therapy in terms of median progression-free survival (11.6 months versus 6 months; p = 0.05), 1-year progression-free survival rate (43.2 % versus 21.7 %; p = 0.05), median overall survival (29.7 months versus 22 months; p = 0.05), and 2-year survival rate (64.9 % versus 43.5 %; p = 0.05).ConclusionsIn metastatic male breast cancer patients, the combined use of gonadotropin-releasing hormone analogues and aromatase inhibitors or antiandrogens seems to be associated with greater efficacy, particularly in terms of survival outcomes, compared with monotherapy. Collectively, these results encourage considering these agents in the metastatic setting.

Clinicopathological and Immunohistochemical Characteristics in Male Breast Cancer: A Retrospective Case Series.

Due to its rarity, male breast cancer (mBC) remains an inadequately characterized disease, and current evidence for treatment derives from female breast cancer (FBC). We retrospectively analyzed the clinicopathological characteristics, treatment patterns, and outcomes of mBCs treated from 2000 to 2013. From a total of 97 patients with mBC, 6 (6.2%) with ductal in situ carcinoma were excluded, and 91 patients with invasive carcinoma were analyzed. Median age was 65 years (range: 25-87 years). Estrogen receptors were positive in 88 patients (96.7%), and progesterone receptors were positive in 84 patients (92.3%). HER-2 was overexpressed in 13 of 85 patients (16%). Median follow-up was 51.5 months (range: 0.5-219.3 months). Five-year progression-free survival (PFS) was 50%, whereas overall survival (OS) was 68.1%. Patients with grades 1 and 2 presented 5-year PFS of 71% versus 22.5% for patients with grade 3 disease; 5-year OS was 85.7% for patients with grades 1 and 2 versus 53.3% of patients with grade 3. Ki-67 score >20% and adjuvant chemotherapy were also statistically significant for OS on univariate analyses. Twenty-six of 87 patients (29.8%) experienced recurrent disease and 16 of 91 patients (17.6%) developed a second neoplasia. Male breast cancer shows different biological patterns compared with FBC, with higher positive hormone-receptor status and lower HER-2 overexpression. Grade 3 and Ki-67 >20% were associated with shorter OS. There is little evidence that prognostic features established in female breast cancer, such as grading and Ki-67 labeling index, could be applied to male breast cancer as well. This study found that grade 3 was associated with shorter overall survival and a trend for Ki-67 >20%; this could help in choosing the best treatment option in the adjuvant setting. Many questions remain regarding the impact of HER-2 positivity on survival and treatment with adjuvant anti-HER-2 therapy. Regarding metastatic male breast cancer, the results suggest that common regimens of chemo-, endocrine and immunotherapy used in female breast cancer are safe and effective for men. Male breast cancer patients show a higher incidence of second primary tumors, especially prostate and colon cancers and should therefore be carefully monitored.

Aromatase inhibitors in male breast cancer: a pooled analysis.

Although several studies have shown the efficacy of third-generation aromatase inhibitors (AIs) in women with breast cancer, the role of such molecules remains elusive in male breast cancer patients. It is also unknown whether the addition of gonadotropin-releasing hormone (GnRH) analogues to AIs would be a superior strategy or not. This pooled analysis was conducted in accordance with the PRISMA guidelines. All studies that examined the efficacy of AIs in metastatic male breast cancer were considered eligible. Overall, 15 studies (105 cases) were eligible for this pooled analysis. The mean age of the study sample was 62.8years. ER status was positive in all eligible cases. AI was given as first line in 61.5% of cases. GnRH analogue was co-administered with AI in 37.1% of cases (n=39). CR, PR, SD and PD were achieved in 5.7, 23.8, 37.2 and 33.3% of cases, respectively. The median PFS and OS were equal to 10.0 and 39.0months, respectively. Co-administration of GnRH analogues was associated with more than threefold increase in rates of clinical benefit (OR=3.37, 95% CI 1.30-8.73) but did not seem to correlate with better PFS or OS. No statistically significant associations between the examined outcomes and the other parameters were noted. Available data suggest that AIs may potentially play a promising role in the optimal therapeutic strategy for metastatic male breast cancer patients. Especially, co-administration of AI with a GnRH analogue seems to increase the rate of clinical benefit and could be more effective, warranting further consideration.

Efficacy of chemotherapy in metastatic male breast cancer patients: a retrospective study.

BackgroundThe role of chemotherapy in the treatment of metastatic male breast cancer patients remains unknown, and the only available evidence stem from small, retrospective series evaluating outdated drugs and/or regimens.MethodsIn this retrospective study we evaluated the activity of polychemotherapy, consisting of three-drug (anthracycline-containing and anthracycline-free) regimens, as a first-line therapy for metastatic male breast cancer patients who had received at least one prior endocrine therapy.ResultsFifty patients treated between 1978 and 2013 were included in the present analysis. Regarding best response, we recorded 1 (2%) complete response and 27 (54%) partial responses, for an overall response rate of 56% (95% CI, 42.2-69.8). Considering stable disease, the disease control rate was 84%. Median progression-free survival was 7.2 months (95% CI, 5.9-8.5), and median overall survival was 14.2 months (95% CI, 12.2-16.2). Albeit we observed some differences for all the outcomes explored when comparing anthracycline-containing and anthracycline-free regimens, they were not statistically significant.ConclusionsChemotherapy, consisting in both anthracycline-containing and anthracycline-free regimens, showed encouraging antitumor activity in metastatic male breast cancer patients previously treated with endocrine therapy.

Antiandrogen therapy in metastatic male breast cancer: results from an updated analysis in an expanded case series.

Male breast cancer is a rare disease treated as hormone receptor-positive female breast cancer. The characterization of breast cancer at the molecular level has lately revealed gender-related differences. As the androgen receptor is emerging as a potential oncogenic driver in male breast cancer, we analyzed efficacy data from metastatic patients treated with antiandrogens. We evaluated the activity of cyproterone acetate, either as a monotherapy or combined with a GnRH analog, in 36 metastatic male breast cancer patients. Fourteen patients were treated with cyproterone acetate as monotherapy and 22 patients with complete androgen blockade. We recorded 4 complete responses and 15 partial responses, for an overall response rate of 52.8% (95% CI, 36.5-69.4). Stable disease was reported in 11 patients. Median PFS was 8.9months (95%CI, 6.1-11.7), and median OS was 24.3months (95%CI, 22.5-26.1). Data on androgen receptor expression were available for 7 patients. All the 4 patients with androgen receptor-expressing tumors had a clinical benefit, including a patient with an estrogen receptor-negative disease. Conversely, none of the 3 patients with androgen receptor-negative tumors had a tumor response. Antiandrogen-based therapy showed efficacy in metastatic male breast cancer patients. Our results encourage considering antiandrogens in the therapeutic continuum, especially if supported by androgen receptor expression.

Aromatase inhibitors for metastatic male breast cancer: molecular, endocrine, and clinical considerations.

Male breast cancer is a rare condition. Aromatase inhibitors are widely used for treating metastatic male breast cancer patients. In this setting, their use is not substantiated by prospective clinical trials, but is rather driven by similarities supposedly existing with breast cancer in postmenopausal women. This oversimplified approach was questioned by studies addressing the molecular and endocrine roots of the disease. In this manuscript, we discuss relevant aspects of the current use of aromatase inhibitors in metastatic male breast cancer in light of the most updated evidence on the molecular landscape of the disease and the specific changes in the hormonal background occurring with aging. We further point to strategies for blocking multiple hormonal pathway nodes with the goal of improving their therapeutic potential. We searched PubMed from its inception until March 2014 for relevant literature on the use of aromatase inhibitors in metastatic male breast cancer. Selected terms were combined and used both as medical headings and text words. The reference list of the suitable manuscripts was inspected for further publications. Aromatase inhibitors represent the mainstay of treatment in the metastatic setting. Yet, efforts aimed at sharpening the therapeutic potential of aromatase inhibitors still pose a challenge due to the paucity of data. The choice of dual hormonal (or sequential) therapy combining aromatase inhibitors with a GnRH analogue may represent a valid alterative, particularly if informed by cancer- and patient-related features including molecular, endocrine, and clinic characteristics.

Metastatic Male Breast Cancer with Rectal Involvement: First Reported Case: Presidential Poster

Purpose: Breast cancer is the most common cause of cancer, and is the second most common cause of cancer-related deaths in women in the United States. Furthermore, the gastrointestinal tract is an uncommonly reported site for metastatic disease of the breast, with the majority of metastasis involving the stomach. Although described in only a handful of cases in women, to our knowledge and extensive literature search, this is the first report of a rectal metastasis from breast cancer in a male patient. We present a case of a 63-year-old male with past medical history of HER 2 positive intraductal breast cancer, diagnosed in 2000 and treated with a modified radical mastectomy, lymph node dissection, and herceptin and aromatase inhibitor therapy. In 2007, he was found to have bony metastasis, after which he resumed chemotherapy until 2010. Patient now presented to our hospital with progressive generalized weakness, nausea, vomiting, and significant diarrhea over the past two months. He reported having approximately 10 bowel movements a day, which resulted in a 25-pound weight loss. On presentation, he also complained of urgency associated with fecal incontinence and decreased appetite. Patient's vital signs were within normal limits. On physical exam, he was alert, with evidence of dry mucous membranes, and otherwise an unremarkable cardiopulmonary and abdominal exam. His laboratory blood work was significant for hemoglobin of 10.3 mg/dl, a normal basic metabolic panel, and negative stool studies for infection. A previous colonoscopy in 2006 was normal. Patient's upper endoscopy showed no signs of bleeding, infection or malignancy. His colonoscopy showed a circumferential villous-appearing mass at 12 cm from the entry site with a narrowed lumen, which was difficult to traverse. An ultra-thin endoscope was used to maneuver through the strictured mass, measuring 5 cm and located from 12 cm to 17 cm from the entry site. Multiple mucosal biopsies from this lesion showed normal colonic mucosa without any evidence of dysplasia or malignancy. A follow-up rectal endoscopic ultrasound showed a submucosal mass measuring 3.3 cm by 1.9 cm, breaching the muscularis propria. Fine needle biopsy showed highly atypical discohesive cells resembling patient's breast cancer histology and immunostaining positive for cytokeratin 7, 20, and GCDFP-15, consistent with patient's breast cancer. He is being evaluated by oncology and colorectal surgery with a plan for chemotherapy. Our case highlights a rare occurrence of metastatic breast cancer to the rectum in a male patient, which should be a part of the differential diagnosis for patients presenting with gastrointestinal complaints after a history of breast cancer, regardless of patient gender.

Letrozole combined with gonadotropin-releasing hormone analog for metastatic male breast cancer

The role of aromatase inhibitors combined with gonadotropin-releasing hormone analog in metastatic male breast cancer patients remains unknown. In this retrospective study we evaluated the activity of letrozole combined with a gonadotropin-releasing hormone analog as a first- or second-line therapy for metastatic male breast cancer patients. 19 men entered the study. We did not observe any grade 3 or 4 adverse events. 2 patients (10.5 %) had complete response, 7 patients (36.8 %) experienced a partial response, 7 patients (36.8 %) had stable disease lasting ≥ 6 months, and 3 patients (15.8 %) had progressive disease. Overall, the disease control rate was 84.2 %. Median progression-free survival was 12.5 months (95 % CI 8.2-16.9), median overall survival was 35.8 months (95 % CI 24.4-49.2), 1- and 2-year survival rates were 89.5 and 67 %, respectively. Interestingly, 3 out of 4 patients treated with the combination following disease progression while on aromatase inhibitor monotherapy confirmed or improved the best overall response observed in the first-line setting. The combination of letrozole and gonadotropin-releasing hormone analog is effective and safe in hormone-receptor positive, metastatic male breast cancer patients.