Results of initial doxorubicin, 5-fluorouracil, and cyclophosphamide combination chemotherapy for inflammatory carcinoma of the breast

Abstract

Forty-three patients with nonmetastatic inflammatory breast carcinoma have been treated by initial doxo-rubicin, 5-fluorouracil, and cyclophosphamide (FAC) combination chemotherapy. After three chemotherapy cycles, responding patients underwent surgery. Chemotherapy was then completed for nine cycles of FAC followed by locoregional radiation therapy. All patients received tamoxifen 40 mg/day for 1 year from the time of diagnosis. Thirty-eight patients (88%) had a clinical response to chemotherapy and underwent surgery. On histologic examination 17 patients had a residual tumor mass less than 1 cm diameter or a complete tumor disappearance; lymph nodes dissection was negative in 15 patients. With a median follow-up of 48 months, the predicted 5-year disease-free survival (DFS) is 48% (median DFS, 46 months). Analysis of prognosis factors shows that age, menopausal status, and histologic grade have no predictive value. The DFS and overall survival were significantly improved by the presence of hormonal receptors and a low number of positive lymph nodes (<4) at surgery. The most significant prognosis factor was the residual tumor mass after initial chemotherapy with an 80% predicted 5-year DFS for the responding patients versus 30% for the no responding patients (P < 0.001). Cancer 65:851-855, 1990. ETWEEN 2% and 5% of breast cancers are inflam-B matory carcinomas. Their prognosis is especially poor. Clinical signs of inflammatory breast carcinoma include elevation of skin temperature, pain, erythema, and edema with dimpling. An tumor mass is rarely palpable. In the PEV2 type, acute inflammatory carcinoma involves more than one third of the breast, whereas in PEV3 type the acute process involves the whole breast. Subcutaneous lymphatic vessels are often invaded by the tumor as demonstrated at skin biopsy,2 but histopatho-logic changes of the skin are not pathogn~monic.~ Prognosis is a major concern. Most cases experience early metastatic dissemination in the first 2 years after Disease-free survival (DFS) rates after 5 years are below lo%, after surgery, radiation therapy, or both.'-' I Initial multiple drug regimens have increased DFS and 5-year survival rates to about 40%."-ls This study reports the results of a treatment strategy for inflammatory breast cancer. Initial chemotherapy in

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

“…However, even if comparisons remain difficult, these results of HDC, including those of our present series, are encouraging when compared to conventional chemotherapy. 3,4,22,40,41 The long period of observation may introduce bias in favour of HDC that we have delivered to our more recent patients. Recent data for IBC show improvement in survival with more modern regimens.…”

“…of patients (% of evaluated cases) (not significant). These rates are comparable with those published for conventional or semi-intensive chemotherapy (from 0 to 25%) 4,8,[24][25][26][27] and for HDC with HSCS (from 14 to 39%). 10,23,28,29 As pathological response has been reported as a prognostic factor, 4,5,[24][25][26]30,31 the identification of predictive factors is warranted.…”

“…Achievement of a clinical or pathological response to conventional chemotherapy has often been correlated with a longer survival. [4][5][6][24][25][26]30,31 In our series, absence of prognostic significance of PCR might be because of the small number of patients in the conventionally treated group and the predominance of cases treated with HDC among the assessed specimens. Indeed, in this situation, such a correlation appears less evident.…”

“…Reported prognostic features 3 remain contested, although response to conventional chemotherapy -notably pathological response -seems to be a strong indicator of survival. [4][5][6] The optimum neoadjuvant chemotherapy regimen, as well as accurate predictive factors, still have to be defined to improve response rate. Clearly, assessment of new systemic therapeutic approaches and better characterization of disease are required.…”

High-dose chemotherapy with peripheral blood stem cell support for stage IIIB inflammatory carcinoma of the breast

“…1,2 The usual sequence of treatment involves induction chemotherapy followed by surgery, radiation therapy, further chemotherapy and hormonal therapy resulting in 5 year event-free survivals (EFS) of approximately 30%. 1,[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] The use of induction chemotherapy and local-regional radioCorrespondence: Dr CD Buckner, Response Oncology, Inc., 600 Broadway, Suite 112, Seattle, WA 98122, USA Received 18 January 1999; accepted 15 April 1999 therapy has decreased local progression of disease but the majority of patients relapse at distant sites making eradication of microscopic metastatic disease the major challenge.…”