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

Abstract

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.

Prognostic Impact of Stromal Immune Infiltration before and after Neoadjuvant Chemotherapy (NAC) in Triple Negative Inflammatory Breast Cancers (TNIBC) Treated with Dose-Dense Dose-Intense NAC

“…Masuda et al [10], in a monocentric cohort of 139 patients with TNIBC, reported a pCR of 12%. In the studies using HDC-AHSCT for IBC, the pCR rate was not higher-21% in the Dazzi et al [28] study and 28% in the Boudin et al [12] study-but the treatment was more toxic and expensive [29]. In our study, the pCR group had a significantly higher median EFS than the non-pCR group.…”

“…IBC's distribution is different from the non-inflammatory breast cancers, with more HER2-positive (38-40%) and triple negative IBC (TNBC) (30%) and fewer patients with ER + tumors (45-50%) [9][10][11]. Triple negative IBC has the worst prognosis [10,12]. Only two series have reported the outcome of triple negative IBC (TNIBC) [10,12].…”

“…Triple negative IBC has the worst prognosis [10,12]. Only two series have reported the outcome of triple negative IBC (TNIBC) [10,12]. Masuda et al [10] a very poor outcome in 139 patients with TNIBC with a pathological complete response (pCR) of 12.4%, five-year disease-free survival (DFS) and overall survival (OS) of 17.5% and 24.3%, respectively.…”

“…Masuda et al [10] a very poor outcome in 139 patients with TNIBC with a pathological complete response (pCR) of 12.4%, five-year disease-free survival (DFS) and overall survival (OS) of 17.5% and 24.3%, respectively. Boudin et al [12] reported a pCR of 28% and a five-year DFS and OS of 58% and 57%, respectively, in a small cohort of 20 TNIBC patients treated with high-dose neoadjuvant chemotherapy (NAC) with autologous hematopoietic stem cell transplantation (HDC-AHSCT). So far, it is recommended that one use the same neoadjuvant chemotherapy regimen in inflammatory breast cancers as in non-inflammatory disease, i.e., a three-week regimen of an anthracyclin-cyclophophamide combination followed by taxanes [13].…”

Dual HER2 Suppression with Lapatinib plus Trastuzumab for Metastatic Inflammatory Breast Cancer: A Case Report of Prolonged Stable Disease

“…Survival has improved with the advent of HER2-targeted therapies for HER2+ disease (trastuzumab was first approved in the US in 1998) [8], with a retrospective study reporting a 5-year survival rate of 53% for patients diagnosed between 1989 and 2011 with primary stage III, hormone receptor-negative, HER2+ inflammatory breast cancer who received neoadjuvant chemotherapy and underwent definitive surgery ( n = 122) [14]. A smaller, single-institution retrospective study in France reported a 5-year survival rate for patients diagnosed between 2003 and 2012 with non-metastatic inflammatory breast cancer of 74% for all subtypes ( n = 67), and 89% for HER2+ disease ( n = 21); all patients were treated with high-dose chemotherapy with autologous hematopoietic stem cell transplantation in the neoadjuvant setting, in addition to other therapy (including trastuzumab for HER2+ tumors from 2005) [15]. Optimization of maintenance therapy after neoadjuvant treatment and surgery should continue to improve treatment outcomes.…”