Outcomes of inflammatory versus noninflammatory T4 breast cancers in the age of taxanes and trastuzumab.

Abstract

e11584 Background: Modern outcomes for inflammatory breast cancer (IBC) and non-inflammatory (non-IBC) stage T4 breast cancers are unknown. Our objective was to determine the rates of overall survival (OS), locoregional control (LRC), and distant metastases free survival (DMFS) in patients with T4 breast cancer in the modern treatment era of taxanes and trastuzumab. Methods: We retrospectively reviewed the charts of all 169 patients diagnosed with non-metastatic T4 breast cancers from 2000-2009 at the Cleveland Clinic. Kaplan-Meier curves were created to determine OS, LRC, and DMFS. Results: Overall, 104 (62%) patients had IBC and 65 (38%) patients had non-IBC T4 cancers. Comparing IBC and non-IBC patients, respectively, 57 (55%) and 17 (26%) were ER/PR negative, 34 (33%) and 8 (12%) were Her2/neu amplified, 75 (72%) and 31 (48%) were clinically node positive, and 62 (60%) and 38 (59%) were pathologically node positive. For the entire cohort, 129 (76%) patients completed all planned therapies (chemotherapy, surgery, and radiation, when indicated), 128 (76%) patients received a taxane, and 28 of 42 (67%) patients with Her2/neu amplified tumors received trastuzumab. In the IBC and non-IBC groups, 100 (96%) and 26 (40%) patients received upfront chemotherapy, and 23% (23/100) and 12% (3/26) achieved a pathologic complete response, respectively. Comparing outcomes of IBC to non-IBC, the five-year OS, LRC, and DMFS were 46% vs. 61% (p=0.15), 83% vs. 97% (p=0.01), and 44% vs. 59% (p=0.04), respectively. On multivariate analysis using Cox proportional hazards regression, significant predictors of distant metastases included inability to complete all planned therapies, ER/PR negative, and clinical lymph node positivity, while significant predictors of complete response to chemotherapy were IBC and use of a taxane. Conclusions: Outcomes for IBC were worse than those for non-IBC T4 breast cancers. Despite taxane-based chemotherapy and trastuzumab, overall outcomes for IBC remain poor and more aggressive strategies are needed.