Contemporary Inflammatory Breast Cancer Therapy Yields Low Local/Regional Recurrence

In In The News by Barbara Jacoby

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From: The American Society of Breast Surgeons

Aggressive Triple-Modality Therapy Prevents Cancer from Returning in the Chest Wall and Lymph Nodes

Current triple-modality therapy for highly aggressive inflammatory breast cancer achieved a 95.5% five-year survival rate with no local cancer recurrence, similar to other breast cancers, in a new study presented this week at the Annual Meeting of the American Society of Breast Surgeons.

The therapy, combining neoadjuvant chemotherapy (chemotherapy prior to surgery), mastectomy and post-surgical radiation, follows current guidelines for treatment of non-metastatic inflammatory breast cancer confined to the breast area.

“Inflammatory breast cancer is a rare disease that progresses rapidly. It represents only about one to two percent of all breast cancer diagnosed in the U.S.,” notes lead researcher Dr. Kelly Rosso, M.D., Fellow, Breast Surgical Oncology at MD Anderson. “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. Because the disease presents differently than other breast cancers and is so aggressive, it is typically found at an advanced stage.”

The study examined a cohort of 114 patients treated between 2007 and 2016, who were identified from a prospective inflammatory breast cancer database. All patients were diagnosed with stage III disease. Only four patients had a local/regional recurrence.

On post-treatment pathology reports, 113 patients (99%) had clear margins with no disease remaining at mastectomy tissue edges. Four women (3.5%) had close margins, with cancer close to but not touching their mastectomy edges (<2mm), and one patient (0.88%) had positive final margins with cancer cells at the mastectomy surgical edge. The patient with positive margins had a recurrence in the axillary lymph nodes. No patient with close margins had a recurrence.

In the patient group, 69 women (61%) had less than three positive nodes after treatment. Of these, two women had a local/regional recurrence. Forty-five patients (39%) had more than four positive nodes and two had a similar recurrence. Two of the 34 patients who had a pathologic complete response (pCR) to chemotherapy had a recurrence. pCR represents the absence of residual invasive local/regional disease following pre-surgical chemotherapy and generally correlates with better overall prognosis.

Dr. Rosso notes that in this study, five-year disease-free survival (DFS) was 72.5%, significantly lower than local/regional recurrence-free survival because some patients developed metastatic cancer in other organs.

“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,” she says. “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.”

“Women concerned with inflammatory breast cancer should watch for redness, swelling and dimpling of the breast skin similar to an orange peel. This is a result of cancer cells blocking the lymphatic flow,” advises Dr. Rosso. “Unlike other breast cancers, inflammatory cancer is usually not characterized by a lump. If you notice any of these symptoms, immediately see your doctor.”

Expert Commentary:

Inflammatory breast cancer represents the aggressive end of the spectrum of breast cancer at presentation. It is encouraging to see the high five-year breast cancer specific survival rates reported in this cohort of 114 women,” said Judy C. Boughey, M.D., a breast surgeon at the Mayo Clinic and chair of the publications committee of the ASBrS. “This study supports that the current management of these patients with neoadjuvant chemotherapy, mastectomy and post-mastectomy radiation is the optimal multimodal approach for inflammatory breast cancer. The improvements in systemic therapy, with increased use of directed therapy, being used in breast cancer, together with appropriate local-regional therapies, is likely responsible for the improvement in survival over historical cohorts.”