Inflammatory Breast Cancer (Fact Sheet)

How is inflammatory breast cancer treated?

Inflammatory breast cancer is generally treated first with systemic chemotherapy to help shrink the tumor, then with surgery to remove the tumor, followed by radiation therapy. This approach to treatment is called a multimodal approach. Studies have found that women with inflammatory breast cancer who are treated with a multimodal approach have better responses to therapy and longer survival. Treatments used in a multimodal approach may include those described below.

Neoadjuvant chemotherapy: This type of chemotherapy is given before surgery and usually includes both anthracycline and taxane drugs. Doctors generally recommend that at least six cycles of neoadjuvant chemotherapy be given over the course of 4 to 6 months before the tumor is removed, unless the disease continues to progress during this time and doctors decide that surgery should not be delayed.
Targeted therapy: Inflammatory breast cancers often produce greater than normal amounts of the HER2 protein, which means that drugs such as trastuzumab (Herceptin) that target this protein may be used to treat them. Anti-HER2 therapy can be given both as part of neoadjuvant therapy and after surgery (adjuvant therapy).
Hormone therapy: If the cells of a woman’s inflammatory breast cancer contain hormone receptors, hormone therapy is another treatment option. Drugs such as tamoxifen, which prevent estrogen from binding to its receptor, and aromatase inhibitors such as letrozole, which block the body’s ability to make estrogen, can cause estrogen-dependent cancer cells to stop growing and die.
Surgery: The standard surgery for inflammatory breast cancer is a modified radical mastectomy. This surgery involves removal of the entire affected breast and most or all of the lymph nodes under the adjacent arm. Often, the lining over the underlying chest muscles is also removed, but the chest muscles are preserved. Sometimes, however, the smaller chest muscle (pectoralis minor) may be removed, too.
Radiation therapy: Post-mastectomy radiation therapy to the chest wall under the breast that was removed is a standard part of multimodal therapy for inflammatory breast cancer. If a woman received trastuzumab before surgery, she may continue to receive it during postoperative radiation therapy. Breast reconstruction can be performed in women with inflammatory breast cancer, but, due to the importance of radiation therapy in treating this disease, experts generally recommend delayed reconstruction.
Adjuvant therapy: Adjuvant systemic therapy may be given after surgery to reduce the chance of cancer recurrence. This therapy may include additional chemotherapy, hormone therapy, targeted therapy (such as trastuzumab), or some combination of these treatments.

What is the prognosis of patients with inflammatory breast cancer?

The prognosis, or likely outcome, for a patient diagnosed with cancer is often viewed as the chance that the cancer will be treated successfully and that the patient will recover completely. Many factors can influence a cancer patient’s prognosis, including the type and location of the cancer, the stage of the disease, the patient’s age and overall general health, and the extent to which the patient’s disease responds to treatment.

Because inflammatory breast cancer usually develops quickly and spreads aggressively to other parts of the body, women diagnosed with this disease, in general, do not survive as long as women diagnosed with other types of breast cancer.

It is important to keep in mind, however, that survival statistics are based on large numbers of patients and that an individual woman’s prognosis could be better or worse, depending on her tumor characteristics and medical history. Women who have inflammatory breast cancer are encouraged to talk with their doctor about their prognosis, given their particular situation.

Ongoing research, especially at the molecular level, will increase our understanding of how inflammatory breast cancer begins and progresses. This knowledge should enable the development of new treatments and more accurate prognoses for women diagnosed with this disease. It is important, therefore, that women who are diagnosed with inflammatory breast cancer talk with their doctor about the option of participating in a clinical trial.

Selected References

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Li BD, Sicard MA, Ampil F, et al. Trimodal therapy for inflammatory breast cancer: a surgeon’s perspective. Oncology 2010;79(1-2):3-12. [PubMed Abstract]
Masuda H, Brewer TM, Liu DD, et al. Long-term treatment efficacy in primary inflammatory breast cancer by hormonal receptor- and HER2-defined subtypes. Annals of Oncology 2014; 25(2):384-91. [PubMed Abstract]
Merajver SD, Sabel MS. Inflammatory breast cancer. In: Harris JR, Lippman ME, Morrow M, Osborne CK, editors. Diseases of the Breast. 3rd ed. Philadelphia: Lippincott Williams and Wilkins, 2004.
Ries LAG, Young JL, Keel GE, et al (editors). SEER Survival Monograph: Cancer Survival Among Adults: U.S. SEER Program, 1988-2001, Patient and Tumor Characteristics. Bethesda, MD: NCI SEER Program; 2007. NIH Pub. No. 07-6215. Retrieved April 18, 2012.
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Schairer C, Li Y, Frawley P, Graubard BI, et al. Risk factors for inflammatory breast cancer and other invasive breast cancers. Journal of the National Cancer Institute 2013; 105(18):1373-1384. [PubMed Abstract]
Tsai CJ, Li J, Gonzalez-Angulo AM, et al. Outcomes after multidisciplinary treatment of inflammatory breast cancer in the era of neoadjuvant HER2-directed therapy. American Journal of Clinical Oncology 2015; 38(3):242-247. [PubMed Abstract]
Van Laere SJ, Ueno NT, Finetti P, et al. Uncovering the molecular secrets of inflammatory breast cancer biology: an integrated analysis of three distinct affymetrix gene expression datasets. Clinical Cancer Research 2013; 19(17):4685-96. [PubMed Abstract]
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Yamauchi H, Woodward WA, Valero V, et al. Inflammatory breast cancer: what we know and what we need to learn. The Oncologist 2012; 17(7):891-9. [PubMed Abstract]

Source: National Cancer Institute.

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