Treatment of Inflammatory Breast Cancer (IBC)

At diagnosis, Inflammatory Breast Cancer is either Stage III or IV disease, depending on whether cancer cells have spread only to nearby lymph nodes or to other tissues as well therefore this is considered at least a locally advanced breast cancer. Standard treatments include preoperative chemotherapy or systemic therapy, mastectomy followed by radiotherapy.
Regardless of the stage of the cancer, treatment of IBC requires an experienced multidisciplinary team with demonstrated expertise in the management of this condition and access to more advanced diagnostic tests and new drugs. Participation in a clinical trial of new treatments for IBC is also a good option because IBC is so rare, and these studies often allow access to drugs not available for standard treatment. A referral or second opinion before starting treatment is advisable for this aggressive disease.

Treating Stage III Inflammatory Breast Cancer

IBC that has not spread outside the breast or nearby lymph nodes is stage IIIB or IIIC. Treatment usually starts with chemotherapy (chemo) to try to shrink the tumor. If the cancer is HER2-positive, targeted therapy is given along with the chemo. This is typically followed by surgery (mastectomy) to remove the cancer.

Radiation therapy often follows surgery. In some cases, more chemo may be given after radiation. If the cancer is hormone receptor-positive (ER- or PR-positive), hormone therapy is given as well. Combining these treatments has improved survival significantly over the years but novel treatments are currently being tested to further improve the outcome of these patients and are usually only available in tertiary referral Centers.

Chemotherapy (possibly along with targeted therapy)

Chemo drugs enter the bloodstream and circulate throughout the body to reach and destroy cancer cells wherever they are, so chemo is considered a type of systemic therapy. It treats both the main tumor as well as any cancer cells that have broken off and spread to lymph nodes or other parts of the body.

• Using chemo before surgery is called neoadjuvant or preoperative treatment. Most women with IBC will receive two types of chemo drugs (although not necessarily at the same time):
• An anthracycline, such as doxorubicin (Adriamycin) or epirubicin (Ellence)
• A taxane, such as paclitaxel (Taxol) or docetaxel (Taxotere)
• Other chemo drugs may be used as well.

If the cancer is HER2-positive (the cancer cells have too much of a protein called HER2), the targeted therapy drug trastuzumab (Herceptin) is given as well, sometimes along with another targeted drug, pertuzumab (Perjeta). These drugs can lead to heart problems when given with an anthracycline, so one option is to give the anthracycline first (without trastuzumab or pertuzumab), followed by treatment with a taxane and trastuzumab (with or without pertuzumab).