Inflammatory Breast Cancer Management in the National Comprehensive Cancer Network: The Disease, Recurrence Pattern, and Outcome

Abstract

Background Inflammatory breast cancer (IBC) is an uncommon clinicopathologic entity characterized by rapid progression and aggressive behavior. We used the NCCN Outcomes Database to characterize recurrence patterns and outcomes. Methods Patients with newly diagnosed IBC treated between 1999 and 2009 at 12 NCCN institutions were identified and baseline characteristics obtained. Patients had multimodality therapy if they received two of three treatments: surgery, perioperative (neoadjuvant or adjuvant) chemotherapy, or perioperative radiation. First site of recurrence/metastatic diagnosis was identified. Overall survival was calculated based on stage at diagnosis and receipt of multimodality therapy. Results We identified 673 patients, of which 195 (29%) had metastatic disease at presentation. Median follow-up was 29 months. Of stage III patients, 82% received >1 treatment modality. Among 203 stage III patients who recurred, the most frequent sites of first recurrence were bone (28%), central nervous system (CNS), lung, and liver (all 21%). HER2 positive and triple negative subtypes had higher rates of CNS recurrence (p=0.001). Median survival was 66 months (95% CI 54-107) for stage III and 26 months (95% CI 22-33) for stage IV. Among 82% of stage III patients receiving multimodality therapy, median survival was 107 months (95% CI 71-Not Reached). Conclusions This large, retrospective, multi-institutional study confirms the aggressive clinical features, unique recurrence patterns and adverse prognosis of IBC. The high rate of CNS recurrence among high-risk subtypes, despite the inflammatory nature of the breast cancer, suggests that new strategies are needed for earlier detection or prevention of brain metastases to improve long-term prognosis.

Early prognosis of metastasis risk in inflammatory breast cancer by texture analysis of tumour microscopic images

“…In comparison, the overall number of registered non-inflammatory breast cancer patients during the same period was 4519. Such a small proportion of IBC patients was further reduced by excluding the patients with metastatic presentation of disease at the time of diagnosis (Matro et al 2014). This approach has improved the homogeneity of the patient group and was essential to analyse the occurrence of metastasis as the main event.…”

Influence of patient, physician, and hospital characteristics on the receipt of guideline-concordant care for inflammatory breast cancer

“…IBC is also a relatively rare subtype, comprising approximately 1–5% of all breast cancers among women in the United States [5–9]. Even though IBC accounts for a low percentage of breast cancer cases, it accounts for 7% of all breast cancer deaths since IBC patients have poorer survival than non-IBC breast cancer patients [5,10–12]. IBC patients tend to be younger than other breast cancer patients, with a median age at diagnosis of 57 years compared to 62 for all breast cancers combined [7,8].…”

“…Treatment for IBC is typically multi-modal [12], but outcomes remain worse than for stage-matched non-IBC breast cancer patients. Currently the National Comprehensive Cancer Network (NCCN) recommends neoadjuvant chemotherapy with an anthracycline-based regimen with or without taxanes followed by mastectomy and axillary lymph node dissection.…”

Management of Inflammatory breast cancer: current concepts

“…However, the overall five-year survival rate for patients with IBC is still very low, at ∼20% [7]. Proper management of IBC requires close coordination…”