Inflammatory Breast Cancer IBC Generalities

Inflammatory breast cancer (IBC):
- Is a clinical diagnosis characterized by:
  - The rapid progression of an enlarged breast with skin changes including redness, edema, and peau d’orange
- Skin punch biopsy will demonstrate:
  - Lymphovascular tumor emboli:
    - In approximately 75% of cases:
      - But the absence should not rule out a diagnosis
- Staging scans, including a CT chest / abdomen/ pelvis, PET scan, and / or bone scan:
  - Should be completed prior to initiating treatment
- Inflammatory breast cancer is a clinical stage T4d:
  - And the most fatal form of breast cancer:
    - Accounting for 7% of all breast cancer deaths:
      - Real-world observational data have demonstrated that inflammatory breast cancer has significantly worse survival compared to other non-metastatic locally advanced and metastatic non-inflammatory breast cancers
    - Despite this, 5-year survival of IBC patients has increased from:
      - 40% to 50% in the 1990’s to almost 70% in 2008
- Recent national and international guidelines for IBC recommend:
  - Full staging (PET / CT preferred over CT chest / abdomen / pelvis + bone scan) and bilateral breast and axillary nodal imaging, followed by neoadjuvant systemic therapy, modified radical mastectomy (including level I and II lymph node dissection), and radiation
  - Adjuvant targeted therapy and hormonal therapy should be considered in appropriate cases
  - Notably, lumpectomy is contraindicated
  - Breast reconstruction should be delayed
  - Multi-modal therapy for IBC has resulted in the best overall survival rates
- For HER2-negative breast cancers:
  - Preoperative chemotherapy regimens should include:
    - Sequential doxorubicin and cyclophosphamide followed by a taxane:
      - To achieve the highest pathologic complete response rate
- For HER2-positive breast cancers:
  - Chemotherapy should be used with dual anti-HER2-directed therapy with pertuzumab and trastuzumab:
    - To achieve the best pathologic complete response rate
References
- National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. Breast Cancer. Available with login at: https://subscriptions.nccn.org.
- Fouad TM, Barrera AMG, Reuben JM, Lucci A, Woodward WA, Stauder MC, et al. Inflammatory breast cancer: a proposed conceptual shift in the UICC-AJCC TNM staging system. Lancet Oncol. 2017;18(4):e228-e232.
- Ueno NT, Espinosa Fernandez JR, Cristofanilli M, Overmoyer B, Rea D, Berdichevski F, et al. International consensus on the clinical management of inflammatory breast cancer from the Morgan Welch Inflammatory Breast Cancer Research Program 10th Anniversary Conference. J Cancer. 2018;9(8):1437-1447.
- Rueth NM, Lin HY, Bedrosian I, Shaitelman SF, Ueno NT, Shen Y, et al. Underuse of trimodality treatment affects survival for patients with inflammatory breast cancer: an analysis of treatment and survival trends from the National Cancer Database. J Clin Oncol. 2014;32(19):2018-2024.