Survival of women with inflammatory breast cancer: a large population-based study

Dawood, Shaheenah; Lei, Xiudong; Dent, R; Gupta, Sudeep; Sirohi, Bhawna; Cortés, Javier; Cristofanilli, Massimo; Buchholz, Thomas A.; González-Angulo, Ana M.

doi:10.1093/annonc/mdu121

Cited by 55 publications

(42 citation statements)

References 19 publications

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“…It accounts for less than 3% of all breast cancers, but is responsible for ~10% of all breast cancer-related deaths [1]. While multidisciplinary approaches incorporating neoadjuvant chemotherapy (NACT), surgery, and radiation therapy have modestly improved survival of IBC patients [2,3], IBC has worse survival than stage-matched non-IBC with a 5-year survival of ~30% [4–6]. Hence, there is an urgent unmet clinical need to develop more effective therapies for IBC, and to develop prognostic and predictive biomarkers that identify patients who will potentially benefit from various treatment interventions.…”

Section: Introductionmentioning

confidence: 99%

The combined presence of CD20 + B cells and PD-L1 + tumor-infiltrating lymphocytes in inflammatory breast cancer is prognostic of improved patient outcome

Arias-Pulido

Cimino‐Mathews

Chaher

et al. 2018

Breast Cancer Res Treat

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Purpose: To evaluate protein expression of PD-L1 and CD20 as prognostic biomarkers of patient outcome in inflammatory breast cancer (IBC) samples. Methods: PD-L1 and CD20 protein expression was measured by immunohistochemistry in 221 pretreatment IBC biopsies. PD-L1 was assessed in tumor cells (PD-L1+ tumor cells) and tumor stromal infiltrating lymphocytes (PD-L1+ TILs); CD20 was scored in tumor-infiltrating B cells. Kaplan–Meier curves and Cox proportional hazard models were used for survival analysis. Results: PD-L1+ tumor cells, PD-L1+ TILs, and CD20+ TILs were found in 8%, 66%, and 62% of IBC, respectively. PD-L1+ tumor cells strongly correlated with high TILs, pathological complete response (pCR), CD20+ TILs, but marginally with breast cancer-specific survival (BCSS, P=0.057). PD-L1+ TILs strongly correlated with high TILs, CD20+ TILs, and longer disease-free survival (DFS) in all IBC and in triple-negative (TN) IBC (P<0.035). IBC and TN IBC patients with tumors containing both CD20+ TILs and PD-L1+ TILs (CD20+TILs/PD-L1+TILs) showed longer DFS and improved BCSS (P<0.002) than patients lacking both, or those with either CD20+ TILs or PD-L1+ TILs alone. In multivariate analyses, CD20+TILs/PD-L1+TILs status was an independent prognostic factor for DFS in IBC (hazard ratio (HR): 0.53, 95% CI 0.37–0.77) and TN IBC (HR: 0.39 95% CI 0.17–0.88), and for BCSS in IBC (HR: 0.60 95% CI 0.43–0.85) and TN IBC (HR: 0.38 95% CI 0.17–0.83). Conclusion: CD20+TILs/PD-L1+TILs status represents an independent favorable prognostic factor in IBC and TN IBC, suggesting a critical role for B-cells in anti-tumor immune responses. Anti-PD-1/PD-L1 and B-cell-activating immunotherapies should be explored in these settings.

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Section: Introductionmentioning

confidence: 99%

The combined presence of CD20 + B cells and PD-L1 + tumor-infiltrating lymphocytes in inflammatory breast cancer is prognostic of improved patient outcome

Arias-Pulido

Cimino‐Mathews

Chaher

et al. 2018

Breast Cancer Res Treat

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“…Increasing year of diagnosis was associated with decreasing risk of death from breast cancer. 7 Recent literature suggests that in the age of modern multimodality therapy, outcomes in IFLBC patients have improved dramatically, and 5-year survival now approximates 69%. 8 …”

Section: Introductionmentioning

confidence: 99%

Does nonmetastatic inflammatory breast cancer have a worse prognosis than other nonmetastatic T4 cancers?

Romanoff

Zabor

Petruolo

et al. 2018

Cancer

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BACKGROUND: Both inflammatory (IFLBC) and non-inflammatory T4 (non-IFLBC) breast cancers have a heavy disease burden in the breast; whether IFLBC’s unique biology conveys a higher locoregional recurrence (LRR) risk and worse outcome versus other T4 lesions is uncertain. Here we compare outcomes in IFLBC and non-IFLBC patients treated with modern multimodality therapy. METHODS: Patients with non-metastatic T4 breast cancer treated with neoadjuvant chemotherapy, mastectomy, and radiation therapy between 2006–2016 were identified. Recurrences and survival were compared between IFLBC and non-IFLBC patients overall, and stratified by receptor subtype. RESULTS: Of 199 T4 patients, median age was 52yrs and median clinical tumor size was 7cm. 117 (59%) had IFLBC. At 41mos median follow-up, 4 patients had an isolated LRR, all occurring in IFLBC patients. 5-year isolated LRR in IFLBC patients was 4.8%. Overall, 14 patients had both LRR and distant recurrence (DR); 47 had DR only. 5-year distant recurrence-free survival (DRFS) was similar between IFLBC/non-IFLBC patients (63% vs 71%, log-rank p=0.14). 5-year DRFS was lowest (43%) among triple negative (TN) patients, and was significantly lower for TN IFLBC than non-IFLBC patients (28% vs 62%, log-rank p=0.02). 5-year overall survival (71% vs 74%, log-rank p=0.4) and cancer-specific survival (74% vs 79%, log-rank p=0.23) did not differ between IFLBC/non-IFLBC. CONCLUSIONS: Although IFLBC is often considered a unique biologic subtype, IFLBC and non-IFLBC patients had similar outcomes with modern multimodality therapy; isolated LRR was uncommon. TN subtype in IFLBC patients is associated with poor outcome, indicating the need for new treatment approaches in this group.

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“…In context with our finding Dawood et al and Gogia et al presented similar level of primary metastatic disease of inflammatory breast cancer. These findings emphasis the importance of correct and early diagnosis and therapy at a time point when IBC cells have not spread into the body [27,28].…”

Section: Arch Gynecol Obstetmentioning

confidence: 75%

“…Our findings are in line with the literature. Dawood et al [27] demonstrates in a multivariable model that increasing year of diagnosis is associated with a decreasing risk of death from IBC. In context with our finding Dawood et al and Gogia et al presented similar level of primary metastatic disease of inflammatory breast cancer.…”

Section: Arch Gynecol Obstetmentioning

confidence: 99%

Identifying the impact of inflammatory breast cancer on survival: a retrospective multi-center cohort study

Diessner

Ewijk

Weiß

et al. 2015

Arch Gynecol Obstet

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This BRENDA sub-group analysis, on a German cohort of breast cancer patients confirmed the negative outcome of IBC and the different clinical behavior of IBC subtypes. The best management of IBC requires intensive coordination and cooperation between various clinical disciplines involved in the treatment of IBC patients. Moreover there is a need to identify IBC-specific targeted therapies to improve the curing prospects of this subtype of cancer.

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Survival of women with inflammatory breast cancer: a large population-based study

Cited by 55 publications

References 19 publications

The combined presence of CD20 + B cells and PD-L1 + tumor-infiltrating lymphocytes in inflammatory breast cancer is prognostic of improved patient outcome

The combined presence of CD20 + B cells and PD-L1 + tumor-infiltrating lymphocytes in inflammatory breast cancer is prognostic of improved patient outcome

Does nonmetastatic inflammatory breast cancer have a worse prognosis than other nonmetastatic T4 cancers?

Identifying the impact of inflammatory breast cancer on survival: a retrospective multi-center cohort study

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