High-dose chemotherapy with peripheral blood stem cell support for stage IIIB inflammatory carcinoma of the breast

Abstract

Summary:The purpose of this study was to determine outcomes for 56 patients with inflammatory breast cancer (IBC) receiving high-dose chemotherapy (HDC) with cyclophosphamide, thiotepa and carboplatin (CTCb) with peripheral blood stem cell (PBSC) support. All patients received the same total amount of chemotherapy but there were differences in the sequence of therapy: 15 received induction chemotherapy, chemotherapy mobilization of PBSC and CTCb after surgery (adjuvant group) while 41 received induction chemotherapy with (n = 17) or without (n = 24) chemotherapy for mobilization of PBSC prior to surgery and CTCb after surgery (neoadjuvant group). Median time from diagnosis to HDC was 5.5 months (range 3.5-12.5). Fifty-one patients (91%) required admission to the hospital following HDC for a median of 11 days (range 5-25). There were two (4%) infectious deaths after HDC. Twenty-four patients (43%) have relapsed at a median of 18 months (range 8-50) from diagnosis resulting in death in 34%. The probabilities of overall (OS) and event-free survival (EFS) at 3 years for all 56 patients were 0.72 and 0.53, respectively, with a median followup of 44 months (range 15-76) from diagnosis. There were no differences in OS, EFS or patterns of relapse between patients in the adjuvant or neoadjuvant groups. These sequences of combined modality therapy incorporating HDC are comparable or superior to other intensive approaches for the treatment of IBC. Further improvements will be necessary to decrease systemic recurrences. Keywords: high-dose therapy; inflammatory breast cancer Multi-modality therapy is now the standard of care for patients with inflammatory breast cancer (IBC). 1,2 The usual sequence of treatment involves induction chemotherapy followed by surgery, radiation therapy, further chemotherapy and hormonal therapy resulting in 5 year event-free survivals (EFS) of approximately 30%. 1,[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] The use of induction chemotherapy and local-regional radioCorrespondence: Dr CD Buckner, Response Oncology, Inc., 600 Broadway, Suite 112, Seattle, WA 98122, USA Received 18 January 1999; accepted 15 April 1999 therapy has decreased local progression of disease but the majority of patients relapse at distant sites making eradication of microscopic metastatic disease the major challenge.The potential value of high-dose chemotherapy (HDC) with hematopoietic stem cell support in patients with operable high-risk stage II-III non-inflammatory breast cancer has been reported. [19][20][21][22][23][24][25][26] Evaluation of HDC with stem cell support in patients with IBC is a logical extension of these studies.Results of autologous bone marrow (BM) transplantation for patients with IBC have been included in summaries of transplant results 27,28 and reported by the International Bone Marrow Transplant Registry. 23,29 Recently, there have been two single-center reports of outcomes for patients with stage IIIB IBC with HDC with BM or peripheral blood stem cell (PBSC) support. 30,31 These s...

Multivariate analysis of survival in inflammatory breast cancer: impact of intensity of chemotherapy in multimodality treatment

“…These rates are comparable with those published for conventional or semi-intensive chemotherapy (from 0 to 25%) 4,8,[24][25][26][27] and for HDC with HSCS (from 14 to 39%). 10,23,28,29 As pathological response has been reported as a prognostic factor, 4,5,[24][25][26]30,31 the identification of predictive factors is warranted. To date, no single clinicopathological parameter has been proved reliably predictive in IBC and very few data are available about molecular features.…”

“…Indeed, in this situation, such a correlation appears less evident. 23,28,29 If confirmed, such a difference between conventional and intensive chemotherapy might reflect a selection effect rather than a therapeutic effect: achievement of PCR after conventional doses might occur with a very good prognosis tumour, more prone to display favourable clinical outcome. Whether the protein expression of ERBB2 and P53 have prognostic value in IBC remains to be investigated.…”

“…The long observation period of this study (24 years) and the size of our series (74 patients) might introduce some heterogeneity in patients and treatments and complicate statistics, justifying caution when assessing the value of HDC. However, inclusion criteria and staging evaluation were similar for all women and our two so-defined groups of patients were 23,28,29,[36][37][38][39] or as first-line therapy. 10 Globally, even if it is difficult to compare these studies, which are often multicentre and/or with small heterogeneous cohorts in terms of treatment and follow-up, the 3-or 4-year DFS rates (from 45 to 65%) and OS rates (from 52 to 89%) are similar to each other and comparable to our series.…”

High-dose chemotherapy and autologous peripheral blood stem cell transplantation for primary breast cancer refractory to neoadjuvant chemotherapy

“…Several studies have shown promising results from HDCT in patients with IBC. [12][13][14][15][16] To date, no randomized trial comparing HDCT and conventional therapy in IBC patients has been reported; however, PFS and OS were longer in these studies than in studies of the conventional multidisciplinary approach in IBC patients. In our study, patients with IBC had a 5-year OS of 48% and a 5-year PFS of 39%.…”

Treatment of Unusual Malignant Neoplasias and Clinical Presentations

“…46 Future developments to improve the survival in patients with IBC will likely result from intensive chemotherapy and autologous hematopoietic stem cell transplantation. [48][49][50] Additionally, future interventions may result from ongoing research on genetic determinants of IBC. 38…”