Clinical Outcomes in Two Different Cohorts of Patients with Inflammatory Breast Cancer (IBC) Treated at the MD Anderson Cancer Center: The Experience of the Morgan Welch IBC Research Program and Clinic.

Abstract

Abstract BACKGROUND: Inflammatory Breast Cancer (IBC) is a rare but aggressive manifestation of primary breast cancer. Survival in patients with IBC is significantly lower than for non-IBC breast cancer patients. Appropriate diagnostic and treatment strategies provided by a specialized multidisciplinary team could impact the overall prognosis of the disease. We recently established an IBC research program and clinic including investigators from various disciplines solely dedicated to this disease. We sought to compare the characteristics and clinical outcomes of newly diagnosed IBC patients evaluated and treated using novel diagnostic and therapeutic approaches with an historical cohort of IBC patients treated at our institution.METHODS: We included 240 IBC patients treated at MD Anderson Cancer Center between January 1970 and August 2000. In this analysis we compared characteristics, 1 year progression free survival (PFS) and 1 year survival between the historic cohort and 47 patients diagnosed with IBC and seen at our IBC clinic between August 2007 and September 2008. The new patients are part of a prospective IBC registry. All of them had staging and monitoring with breast MRI and FDG-PET/CT. When indicated, they were treated with targeted therapies (e.g. trastuzumab and tipifarnib), that were not available for the patients in the old cohort. Descriptive statistics were used. Kaplan Meier product-limit method was used to calculate survival outcomes, groups were compare by log-rank test.RESULTS: Median age was similar in both cohorts (53 vs 51). In the new cohort 40% of the patients had evidence of distant metastasis at presentation. The most common sites were contralateral lymph nodes (26%), pleura (16%), bone (16%) and liver (11%). In the old cohort only 17% presented with stage IV. 38.7% of the new patients had Her2-neu amplified and 34%, triple receptor negative IBC. There was no difference in 1-year survival between the two groups (92.4% vs. 93.8%, p=0.637). For patients with stage III disease, the 1-year survival was 95% for both groups. The 1 year-PFS was 86.4% in the new cohort compared to 77.9% (p=0.43) in the old cohort. With a median follow up of 13 months, 51%of the patients in the new cohort are disease free and 87% are still alive.CONCLUSIONS: IBC is an aggressive but rare disease with poor prognosis. We have established a specialized IBC research program and clinic that introduces novel concepts and strategies in laboratory, imaging diagnostics and targeted therapies. This approach may accelerate our understanding of the biology, develop new therapeutic strategies and finally improve the outcome of IBC. Early results of this multidisciplinary approach show a modest, but not significant difference in outcome. We hope that with additional patients and longer follow-up a significant improvement in outcomes will become apparent. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5119.