Neuroendocrine Carcinoma of the Breast: Current Evidence and Future Perspectives

Abstract

Neuroendocrine carcinoma of the breast is considered a rare entity, and for this reason there are no data from prospective clinical trials on its optimal management. Early stage tumors are usually treated with the same strategy used for the other types of invasive breast cancer. Anthracycline-and taxane-based regimens represent the most frequently administered chemotherapy in neoadjuvant and adjuvant setting, as well as for metastatic disease, although combinations of platinum compounds and etoposide have been widely used, in particular for small-cell histology and tumors with a high proliferation index. For metastatic disease, a multimodality therapeutic strategy can be considered on an individual basis, with chemotherapy, endocrine therapy, peptide receptor radionuclide therapy, radiation therapy, surgery, or a combination of the above. In the near future, a better knowledge of the biology of these tumors will hopefully provide new therapeutic targets for personalized treatment. In this review, we discuss the current evidence and the future perspectives on diagnosis and treatment of neuroendocrine carcinoma of the breast. The Oncologist 2016;21:28-32 Implications for Practice: Neuroendocrine carcinoma of the breast (NECB) is a distinct entity of breast cancer. Clinical features and morphology are not helpful to distinguish NECB from other subtypes of breast cancer; therefore, immunohistochemistry markers for neuroendocrine differentiation, mainly chromogranin and synaptophysin, should be routinely used to confirm the diagnosis, especially in cases of mucinous or solid papillary carcinoma in which the suspicion of NECB may be relevant. Adjuvant treatment should be offered according to the same recommendations given for the other types of invasive breast cancer. An accurate diagnosis of NECB is also important in the metastatic setting, in which a multimodality approach including specific therapies such as peptide receptor radionuclide therapy can be considered.

Triple receptor-positive primary neuroendocrine carcinoma of breast in a young patient

“…A preoperative diagnosis of primary neuroendocrine carcinoma with hormone receptor status on biopsy will help us in the early administration of appropriate targeted therapy. Furthermore, most of the neuroendocrine tumours (NETs) express oestrogen and progesterone receptors (ER and PR) but are usually negative for HER2/Neu (Human Epidermal Growth Factor Receptor 2) 7. However, the patient described in this report was positive for Estrogen Receptor (ER), Progesterone Receptor (PR) and HER2/Neu.…”

Métastases intra-mammaires d’une tumeur neuro-endocrine d’origine pulmonaire : place du traitement loco-régional mammaire

“…Devant une é volution plurimé -tastatique viscé rale ou osseuse, le traitement loco-ré gional n'a gé né ralement pas sa place. Ce sont les traitements systé miques qui sont proposé s en premiè re intention [13]. À l'inverse, lorsqu'il s'agit de lé sions mammaires mé tastatiques isolé es, comme cela a é té le cas au dé but de l'é volution de notre patiente, une prise en charge chirurgicale calqué e sur celle des TNE primitives mammaires peut être discuté e. Le traitement conservateur doit être privilé gié chaque fois que celui-ci est techniquement faisable.…”

“…L'é volution loco-ré gionale a é té la même à droite et à gauche, alors qu'une radiothé rapie avait é té ré alisé e à droite. Les nouvelles chimiothé rapies et thé rapies ciblé es, telles que la temozolomide, la rapamycine, les analogues de la somatostatine ou bien encore les inhibiteurs de vascular endothelial growth factor (VeGF) ainsi que la radiothé rapie mé tabolique (peptide receptor radionuclide), dont la place n'est pas encore clairement é tablie, pourront peut-être amé liorer le pronostic [13,15].…”

Clinical and morphological characteristics of neuroendocrine tumors: clinical experience

“…По данным ряда исследований, нейроэндокринная дифференцировка может встречаться в 10-30 % случаев аденокарциномы молочной железы [14,17]. Наиболее частые формы -муцинозный и папиллярный рак молочной железы, которые примерно в 25 % случаев имеют экспрессию нейроэндокринных маркеров [18]. Прогностическое значение нейроэндокринной дифференцировки при раке молочной железы неоднозначно, с противоречи-выми данными в различных исследованиях [19][20][21].…”