Inflammatory Breast Cancer at the Extremes of Age

Abstract

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]

Optimizing Precision Medicine for Breast Cancer Brain Metastases with Functional Drug Response Assessment

“…We also examined oncogenic gene sets. Of the enriched gene sets, as previously noted by others ( 33, 34 ), growth factor pathways such as ERBB2 and EGFR, as well as MTOR and AKT- related sets were enriched. Of the depleted sets, the KRAS -related set was noted to be significantly depleted, as well as PTEN -related sets ( Supplementary Fig.…”

22nd Annual Virtual Meeting of the American Society of Breast Surgeons: Science, Innovation, and Practice Changes

“…6 The Scientific Impact Award went to Dr. David Lim from the Toronto Women's College Research Institute on the relationship between the breast tumor pathologic response to neoadjuvant systemic therapy and axillary nodal response. 7 Much gratitude is given to the 31 members of the Publication Committee for careful blinded review (to both authors and institutional source) of 220 research abstracts for selection of the top studies for oral scientific, ''quickshot,'' and poster-discussion presentations, and for the final review and selection of the highest impact publications for this issue of Annals of Surgical Oncology.Just some of the highlighted research studies published in this issue of Annals of Surgical Oncology include important work regarding post-operative pain management, 8 understanding current axillary management, 9,10 potential new methods for decreasing surgery for margin control, 11 inflammatory breast cancer, 12 cryoablation without surgery for early invasive breast cancer, 13 and how the COVID-19 pandemic has altered practice among our society members. 14 These and other ASBrS articles published in this issue provide current research results germane to today's delivery of high-quality breast cancer care.…”