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

Bertucci, François; Tarpin, Carole; Charafe-Jauffret, Emmanuelle; Bardou, Valérie‐Jeanne; Braud, Anne-Chantal; Tallet, Agnés; Gravis, Gwénaëlle; Viret, F.; Gonçalvès, Anthony; Houvenaeghel, Gilles; Blaise, Didier; Jacquemier, Jocelyne; Maraninchi, D; Viens, Patrice

doi:10.1038/sj.bmt.1704458

Cited by 30 publications

(17 citation statements)

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“…Population-based data suggest that 25% of IBC patients have distant disease at diagnosis 4 . Overall survival is also shorter than with non-IBC; single institution series suggest a 5-year and 15-year survival of approximately 40% and 20%, respectively 4-7 .…”

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confidence: 93%

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

Matro

Cristofanilli

et al. 2015

Clinical Breast Cancer

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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.

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confidence: 93%

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

Matro

Cristofanilli

et al. 2015

Clinical Breast Cancer

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“…Amongst the many therapeutic options evaluated in IBC, high-dose chemotherapy with autologous hematopoietic stem cells transplantation (HDC-AHSCT) has a special place. Disappointing results of conventional chemotherapy, demonstrated dose response and dose intensity relationships with alkylating agents 45 and prognostic impact of initial response to neo adjuvant chemotherapy led to several investigations of HDC strategies in the 90's with encouraging results 6 7 8 9 . The main phase 2 study conducted to completion (PEGASE 02) showed 32% of pathological complete responses (pCR) post HDC and a 3-year overall survival (OS) rate of 70% 10.…”

Section: Introductionmentioning

confidence: 99%

Prognostic impact of hormone receptor- and HER2-defined subtypes in inflammatory breast cancer treated with high-dose chemotherapy: a retrospective study

Boudin¹,

Gonçalvès²,

Sfumato³

et al. 2016

J. Cancer

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Purpose: Studies examining high-dose chemotherapy with autologous hematopoietic stem cell transplantation (HDC-AHSCT) strategies in inflammatory breast cancer (IBC), showed encouraging results in terms of disease-free survival (DFS), and overall survival (OS). The lack of data regarding HER2 status in all of these studies prevented any prognostic analysis involving breast cancer subtypes.Methods: All consecutive female patients treated for IBC with HDC and AHSCT at Institut Paoli-Calmettes between 2003 and 2012 were included. Since 2005, trastuzumab was included in initial treatment. Patient, tumor and treatment characteristics were collected. Patients were categorized in three subtypes based on hormonal receptor (HR) and HER2 status of the primary tumor: Luminal, (HR+/HER2-), HER2 (HER2+, any HR), and triple negative (TN) (HER2- and HR-). The main objective was the analysis of OS according to the IHC subtypes.Results: Sixty-seven patients were included. Eleven patients received trastuzumab. Median follow up was 80.04 months (95% CI 73.2-88.08). Five-year OS and DFS for the whole population patients were 74% (95% CI 61-83) and 65 % (95% CI 52-75), respectively. OS differed across subtypes (p=0.057) : HER2 subgroup appeared to have the best prognosis with a 5-year OS of 89% (95% CI 64-97) compared to 57% (95% CI 33-76) for the TN subgroup (HR 5.38, 95% CI 1.14-25.44; p=0.034).Conclusions: In IBC patients receiving HDC-AHSCT, OS favorably compares with data available in the literature on similar groups of patients. TN patients carried the least favourable OS and HER2 patients, half of them also receiving trastuzumab, had the best outcome. These findings provide additional information and options for patients with IBC and who could potentially benefit of HDC-AHSCT.

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“…The current consensus treatment is first-line chemotherapy with an anthracycline-based regimen, possibly combined with a taxane, followed by mastectomy and axillary lymph node dissection for responders, locoregional radiotherapy and, when appropriate, hormone therapy [3,4]. The benefits of dose-intensive therapy and bone marrow transplantation are not clearly established in this setting [5,6]. Maintenance adjuvant chemotherapy and new therapeutic approaches are under study.…”

Section: Introductionmentioning

confidence: 99%

Update on inflammatory breast cancer

2005

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52 bFGF = basic fibroblast growth factor; ER = estrogen receptor; IBC = inflammatory breast cancer; IL = interleukin; LABC = locally advanced breast cancer; RT-PCR = reverse transcriptase-polymerase chain reaction; VEGF = vascular endothelial growth factor. Breast Cancer Research Vol 7 No 2 Lerebours et al. AbstractInflammatory breast cancer (IBC) is both the least frequent and the most severe form of epithelial breast cancer. The diagnosis is based on clinical inflammatory signs and is reinforced by pathological findings. Significant progress has been made in the management of IBC in the past 20 years. Yet survival among IBC patients is still only one-half that among patients with non-IBC. Identification of the molecular determinants of IBC would probably lead to more specific treatments and to improved survival. In the present article we review recent advances in the molecular pathogenesis of IBC. A more comprehensive view will probably be obtained by pan-genomic analysis of human IBC samples, and by functional in vitro and in vivo assays. These approaches may offer better patient outcome in the near future. IntroductionInflammatory breast cancer (IBC) is diagnosed on the basis of signs of rapid progression, such as localized or generalized breast induration, redness and edema [1]. IBC accounts for less than 5% of all diagnosed breast cancers [2].IBC is the most lethal form of primary breast cancer [2]. Surgery and/or radiation therapy offers a 5-year survival rate of less than 15% [1]. The current consensus treatment is first-line chemotherapy with an anthracyclinebased regimen, possibly combined with a taxane, followed by mastectomy and axillary lymph node dissection for responders, locoregional radiotherapy and, when appropriate, hormone therapy [3,4]. The benefits of dose-intensive therapy and bone marrow transplantation are not clearly established in this setting [5,6]. Maintenance adjuvant chemotherapy and new therapeutic approaches are under study. Despite multimodality treatments, the prognosis remains poor, with a 3-year survival rate of only about 40%, compared with 85% among patients with non-IBC [2,3]. These survival data have hardly improved in the past 5 years [3,7].The main issue in IBC is to identify the specific pattern of genetic changes accounting for this particular phenotype and aggressiveness, so that we can develop more effective targeted treatments. Little is known of these biological and molecular mechanisms, for several reasons. First, IBC is rare. Second, the small size of diagnostic samples may have hindered past molecular studies. Third, because of their similar treatment, IBC is rarely studied separately from other forms of locally advanced breast cancer (LABC), despite differences in age-specific incidence rates, clinical presentation, histology, hormone receptor status and, finally, prognosis [8][9][10][11]. The molecular mechanisms underlying these distinct clinicopathological entities are likely to differ, and should thus be studied comparatively.It is highly probable that the...

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

Cited by 30 publications

References 40 publications

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

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

Prognostic impact of hormone receptor- and HER2-defined subtypes in inflammatory breast cancer treated with high-dose chemotherapy: a retrospective study

Update on inflammatory breast cancer

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