Update on the management of inflammatory breast cancer.

Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA.
The Oncologist (Impact Factor: 4.54). 02/2003; 8(2):141-8.
Source: PubMed

ABSTRACT Inflammatory breast cancer (IBC) is the most aggressive manifestation of primary breast carcinoma, with the clinical and biological characteristics of a rapidly proliferating disease. The multidisciplinary management of IBC has changed in the past 3 decades and is presently clearly outlined in sequence, with preoperative or neoadjuvant chemotherapy representing the mainstay of treatment. Anthracyclines and taxanes are the most effective cytotoxic agents in the management of primary breast cancer and should be the standard of treatment for women with IBC. Locoregional treatment includes radiotherapy with or without surgery and continues to play a major role after appropriate medical treatment. The many investigations into the particular molecular determinants of IBC development have provided several interesting new therapeutic targets. Combination regimens that include angiogenic modulators, farnesyl transferase inhibitors, and p53 modulators hold great promise in the medical management of IBC. Future therapeutic approaches should focus on these discoveries so that we can improve the overall prognosis for women with IBC.

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    ABSTRACT: IntroductionCirculating tumor cells (CTCs) are an independent prognostic factor for progression-free survival (PFS) and overall survival (OS) in patients with metastatic breast cancer. Inflammatory breast cancer (IBC) is one of the most aggressive forms of breast cancer. The prognostic value of a CTC count in newly diagnosed IBC has not been established. The aim of this study was to assess the prognostic value of a baseline CTC count in patients with newly diagnosed IBC.Methods This retrospective study included 147 patients with newly diagnosed IBC (77 with locally advanced and 70 with metastatic IBC) treated with neoadjuvant therapy or first-line chemotherapy during the period from January 2004 through December 2012 at The University of Texas MD Anderson Cancer Center. CTCs were detected and enumerated using the CellSearch system before patients were started with chemotherapy.ResultsThe proportion of patients with ¿1 CTC was lower among patients with stage III than among patients with metastatic IBC (54.5% versus 84.3%; P¿=¿0.0002); the proportion of patients with ¿5 CTCs was also lower for stage III than for metastatic IBC (19.5% versus 47.1%; P¿=¿0.0004). Patients with <5 CTCs had significantly better progression-free survival (PFS) (hazard ratio [HR]¿=¿0.60; P¿=¿0.02) and overall survival (HR¿=¿0.59; P¿=¿0.03) than patients with ¿5 CTCs. Among patients with stage III IBC, there was non-significant difference in PFS (HR¿=¿0.66; 95% confidence ratio (CI), 0.31 to 1.39; P¿=¿0.29) and OS (HR¿=¿0.54; 95% CI, 0.24 to 1.26; P¿=¿0.48) in patients with no CTCs compared to patients with ¿1 CTCs. In multivariate analysis, CTC was prognostic for PFS and OS independently from clinical stage.ConclusionsCTCs can be detected in a large proportion of patients with newly diagnosed IBC and are a strong predictor of worse prognosis in patients with newly diagnosed IBC.
    Breast cancer research: BCR 01/2015; 17(1):2. DOI:10.1186/s13058-014-0507-6 · 5.88 Impact Factor
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    ABSTRACT: Background Nonmetastatic non-inflammatory invasive breast cancers having skin involvement (SI) are classified as T4b, regardless of size. This study evaluated disease specific survival (DSS) to determine whether size should be considered for these lesions, rather than grouping them all into Stage III. Study Design Surveillance Epidemiology and End Results data linked to Medicare claims were reviewed. SI and nonSI tumors were reclassified using AJCC 7th Edition groupings using tumor size and nodal involvement alone without considering SI (neostage). DSS was adjusted for demographics, histology and treatment using competing risk methods with propensity score-based weighting and bootstrap standard errors. Results Among 924 SI patients diagnosed between 1992 and 2005, tumors were 0.1-2.0, 2.1-5.0, and >5.0 cm in 11.6%, 51.1%, and 37.3% of cases, respectively. There were no nodal metastases in 22.3%, 1-3 positive nodes in 31.7%, 4-9 positive in 28.6% and ≥10 positive in 17.4% of cases. For SI patients, adjusted 5-year DSS was 95.8% [95%CI: 95.6–96.0] for neostage I, declining progressively to 36.4% [95%CI: 33.8–39.2] for neostage IIIC patients. Adjusted 5-year DSS for SI and nonSI tumors (n=66,185) was similar for neostage I, IIA, and IIB, and markedly lower for IIIA and IIIC. Adjusted DSS for SI IIIA was similar to nonSI IIIC. Conclusions Noninflammatory SI breast cancers have widely varied DSS that differs by tumor size and nodal involvement, and therefore should not all be stage III. SI should be subordinate to T and N groupings to classify SI with nonSI lesions having similar prognoses.
    Journal of the American College of Surgeons 09/2014; DOI:10.1016/j.jamcollsurg.2014.04.003 · 4.45 Impact Factor
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