Biological subtype, treatment response and outcomes in inflammatory breast cancer using data from the National Cancer Database

Kupstas, Amanda; Hoskin, Tanya L.; Day, Courtney N.; Boughey, Judy C.; Habermann, Elizabeth B.; Hieken, Tina J.

doi:10.1002/bjs.11469

Cited by 28 publications

(10 citation statements)

References 34 publications

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“…subtype have been associated with pathologic node negativity, which is predictive of OS 28 after neoadjuvant systemic therapy, approximately only 20% of patients achieve pCR in the breast and axilla. 29 Furthermore, risk stratification methods such as sentinel node biopsy technique have prohibitively high failure rates in IBC patients. Therefore, identification of patients who achieve pCR is challenging.…”

Section: Discussionmentioning

confidence: 99%

Inflammatory Breast Cancer at the Extremes of Age

et al. 2021

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Background. Inflammatory breast cancer (IBC) is a rare breast malignancy with poor outcomes compared with non-IBC. Age-related differences in tumor biology, treatment, and clinical outcomes have been described in non-IBC. This study evaluated age-related differences in IBC. Methods. From an institutional prospective database, patients with an IBC diagnosed from 2010 to 2019 were identified. Age was categorized as 40 years or younger, 41 to 64 years, and 65 years or older. Demographics, clinicopathologic features, and treatment received were compared. Recurrence and survival outcomes were analyzed using the log-rank test and the Cox proportional hazards model. Results. Of 523 IBC patients, 113 (21.6%) were age 40 years or younger, and 72 (13.8%) were age 65 years or older. The groups did not differ statistically by race/ethnicity, N stage, clinical stage, or tumor subtype. The younger patients included a higher proportion of Hispanic and Asian patients, triple-negative breast cancer (TNBC), and clinical N2/N3. Trimodality therapy was received by 92% of the stage 3 patients, with no difference in pathologic complete response (pCR) by age (23.3% vs 28.6%; p = 0.46). During a median follow-up period of 40 months, 17% of the patients experienced locoregional recurrence and 42.8% had distant metastasis. No difference in 3-year recurrence-free survival (57.9% vs 42.6% vs 54%; p = 0.42, log rank) or overall survival (OS) (75.6% vs 77.1% vs 64.4%; p = 0.31, log rank) by age was observed, and no difference in OS by age in de novo stage 4 disease was observed. In the multivariate analysis, worse OS was associated with TNBC (hazard ratio [HR], 1.99, 95% confidence interval [CI], 1.31-3.05) and no pCR (HR, 4.45; 95% CI,. Conclusion. No significant differences were observed in demographics, treatment patterns, or clinical outcomes for IBC patients age 40 years or younger compared with those age 65 years or older treated by a specialized multidisciplinary team. These findings do not support age-related treatment de-escalation in IBC.Inflammatory breast cancer (IBC) is a clinically distinct and aggressive form of breast cancer characterized by diffuse erythema and edema without an underlying mass in up to 50% of cases. 1 Although IBC accounts for only 2% to 6% of all breast cancers, it results in 10% of breast cancerrelated deaths, and nearly 40% of patients are stage 4 at presentation. [2][3][4] Compared with locally advanced non-IBC, the prognosis for IBC is significantly worse, with the 5-year overall survival rate ranging from 34 to 61% compared with 41% to 86% for patients with stage 3 disease. [5][6][7]

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Section: Discussionmentioning

confidence: 99%

Inflammatory Breast Cancer at the Extremes of Age

et al. 2021

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“…Among patients with non-metastatic IBC treated with neoadjuvant chemotherapy and surgery, identified from the National Cancer Database, the pathological complete response (pCR) rate was 19.1% in those with TNBC. Furthermore, such patients had a worse 5-year survival rate (44%) than those with other subtypes ( 4 ). In our case, a skin biopsy showed that both breast cancers were triple-negative; the tumors were successfully treated with induction dose-dense chemotherapy and bilateral total mastectomy, and pCR was nearly achieved.…”

Section: Discussionmentioning

confidence: 96%

“…A previous study conducted using the SEER database showed that patients with IBC had a poorer overall survival and breast cancer-specific survival rates than those with non-IBC ( 3 ). IBC is more often observed in patients with HER2-positive breast cancer and triple-negative breast cancer (TNBC) than non-IBC ( 3 , 4 ). Among patients with non-metastatic IBC treated with neoadjuvant chemotherapy and surgery, identified from the National Cancer Database, the pathological complete response (pCR) rate was 19.1% in those with TNBC.…”

Section: Discussionmentioning

confidence: 99%

Bilateral Inflammatory Breast Cancer That Developed Two Years after Treatment for Triple-negative Breast Cancer

et al. 2022

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A 66-year-old woman underwent partial mastectomy and a sentinel lymph node biopsy for left breast cancer; the pathological diagnosis was invasive ductal carcinoma (pT1aN0, pStage I, triple-negative subtype). Postoperative radiotherapy was performed. Two years later, she developed redness and induration at both breasts. The diagnosis was bilateral inflammatory breast cancer. After four cycles of dose-dense epirubicin and cyclophosphamide followed by 12 weekly paclitaxel cycles, bilateral total mastectomy and axillary lymph node dissection were performed. At the one-year follow-up after undergoing operation and radiotherapy, she remained alive without recurrence. Dose-dense treatment regimens may help patients achieve complete resection without short-term recurrence.

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“…The current standard treatment for stage III IBC consists of tri-modality therapy, which includes neoadjuvant systemic therapy followed by modified radical mastectomy (MRM) and post-mastectomy radiation therapy 9 . The use of tri-modality therapy has been associated with 5-year OS rates ranging from 44% in patients with triple-negative IBC to 74% in patients with HER2 + IBC 10 . The incorporation of HER2-directed agents into tri-modality therapy has significantly improved survival outcomes for patients with HER2 + IBC 11 .…”

Section: Introductionmentioning

confidence: 99%

Clinical outcomes of de novo metastatic HER2-positive inflammatory breast cancer

Garrido-Castro,

Regan,

Niman

et al. 2023

npj Breast Cancer

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Inflammatory breast cancer (IBC) is a rare, aggressive form of breast cancer that presents as de novo metastatic disease in 20–30% of cases, with one-third of cases demonstrating HER2-positivity. There has been limited investigation into locoregional therapy utilization following HER2-directed systemic therapy for these patients, and their locoregional progression or recurrence (LRPR) and survival outcomes. Patients with de novo HER2-positive metastatic IBC (mIBC) were identified from an IRB-approved IBC registry at Dana-Farber Cancer Institute. Clinical, pathology, and treatment data were abstracted. Rates of LRPR, progression-free survival (PFS), overall survival (OS), and pathologic complete response (pCR) were determined. Seventy-eight patients diagnosed between 1998 and 2019 were identified. First-line systemic therapy comprised chemotherapy for most patients (97.4%) and HER2-directed therapy for all patients (trastuzumab [47.4%]; trastuzumab+pertuzumab [51.3%]; or trastuzumab emtansine [1.3%]). At a median follow-up of 2.7 years, the median PFS was 1.0 year, and the median OS was 4.6 years. The 1- and 2-year cumulative incidence of LRPR was 20.7% and 29.0%, respectively. Mastectomy was performed after systemic therapy in 41/78 patients (52.6%); 10 had a pCR (24.4%) and all were alive at last follow-up (1.3–8.9 years after surgery). Among 56 patients who were alive and LRPR-free at one year, 10 developed LRPR (surgery group = 1; no-surgery group = 9). In conclusion, patients with de novo HER2-positive mIBC who undergo surgery have favorable outcomes. More than half of patients received systemic and local therapy with good locoregional control and prolonged survival, suggesting a potential role for local therapy.

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Biological subtype, treatment response and outcomes in inflammatory breast cancer using data from the National Cancer Database

Cited by 28 publications

References 34 publications

Inflammatory Breast Cancer at the Extremes of Age

Inflammatory Breast Cancer at the Extremes of Age

Bilateral Inflammatory Breast Cancer That Developed Two Years after Treatment for Triple-negative Breast Cancer

Clinical outcomes of de novo metastatic HER2-positive inflammatory breast cancer

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