Trimodality Therapy in Inflammatory Breast Cancer Improves Locoregional Control

Researchers were able to achieve improved locoregional control among a cohort of women with nonmetastatic inflammatory breast cancer using trimodality therapy, according to the results of a study presented at the 2017 American Society of Breast Surgeons Annual Meeting, held April 26–30 in Las Vegas.

“Research on inflammatory breast cancer is limited, and this study is important because local reappearance of the disease on the chest wall or in the lymph node basins is extremely difficult to treat,” said researcher Kelly Rosso, MD, a fellow in the department of breast surgical oncology at the University of Texas MD Anderson Cancer Center, in a press release. “Because the disease presents differently than other breast cancers and is so aggressive, it is typically found at an advanced stage.”

According to Rosso, trimodality therapy at MD Anderson is defined as new adjuvant chemotherapy and targeted systemic therapy followed by aggressive surgical resection to negative margins and radiotherapy specific to inflammatory breast cancer.

Rosso and colleagues looked at all patients with newly diagnosed inflammatory breast cancer seen at MD Anderson from 2007 to 2015 (n = 277). Of these patients, 114 had nonmetastatic disease and received aggressive trimodality therapy.

During a median follow-up of 3.6 years, there were 29 deaths and 4 locoregional recurrences.

The 5-year overall survival rate from the date of diagnosis was 69.41% (95% CI, 57.57%–78.54%). The researchers found certain factors to be associated with diminished overall survival, including age 65 or older, HER2-negative disease, limited clinical response to chemotherapy, and absence of pathologic complete response.

There was an increased hazard of recurrence or metastasis among women age 65 or older, and in those who had clinical stage IIIC disease, lymphovascular invasion, HER2-negative disease, advanced N stage, and absence of pathologic complete response.

Rosso said that given the small number of patients with locoregional recurrence, predictors could not be evaluated. The 2-year probability rate of locoregional recurrence was 3.19%, and the 2-year probability rate of recurrence or distant metastasis was 23.10% (95% CI, 16.43%–32.48%).

“While current therapies are achieving strong locoregional control, metastatic disease that has spread beyond the breast area remains a problem for inflammatory breast cancer patients,” noted Rosso in a press release. “Even if patients are not metastatic when diagnosed, cancer cells may be circulating in their blood and will later affect other organs. Clearly, progress means treating the disease on all fronts, and promising research on metastatic disease is emerging.”