Management Of Inflammatory Breast Cancer Research Articles

Self-Reported Management of Inflammatory Breast Cancer Among the American Society of Breast Surgeons Membership: Consensus and Opportunities.

Inflammatory breast cancer (IBC) is rare and biologically aggressive. We sought to assess diagnostic and management strategies among the American Society of Breast Surgeons (ASBrS) membership. An anonymous survey was distributed to ASBrS members from March to May 2023. The survey included questions about respondents' demographics and information related to stage III and IV IBC management. Agreement was defined as a shared response by >80% of respondents. In areas of disagreement, responses were stratified by years in practice, fellowship training, and annual IBC patient volume. The survey was administered to 2337 members with 399 (17.1%) completing all questions and defining the study cohort. Distribution of years in practice was 26.0% 0-10 years, 26.6% 11-20 years and 47.4% > 20 years. Overall, 51.2% reported surgical oncology or breast fellowship training, 69.2% maintain a breast-only practice, and 73.5% treat < 5 IBC cases/year. Agreement was identified in diagnostic imaging, trimodal therapy, and mastectomy with wide skin excision for stage III IBC. Lack of agreement was identified in surgical management of the axilla; respondents with < 10 years in practice or fellowship training were more likely to perform axillary dissection for cN0-N2 stage III IBC. Locoregional management of stage IV IBC was variable. Among ASBrS members, there is consensus in diagnostic evaluation, treatment sequencing and surgical approach to the breast in stage III IBC. Differences exist in surgical management of the cN0-2 axilla with uptake of de-escalation strategies. Clinical trials are needed to evaluate oncologic safety of de-escalation in this high-risk population.

ASO Visual Abstract: Self-Reported Management of Inflammatory Breast Cancer Among the American Society of Breast Surgeons Membership-Consensus and Opportunities.

ASO Visual Abstract: Self-Reported Management of Inflammatory Breast Cancer Among the American Society of Breast Surgeons Membership-Consensus and Opportunities.

ASO Author Reflections: Management of Inflammatory Breast Cancer: No Role for Surgical De-escalation Yet.

ASO Author Reflections: Management of Inflammatory Breast Cancer: No Role for Surgical De-escalation Yet.

Inflammatory Breast Cancer: Challenges and Opportunities in the Management

Background: Inflammatory Breast Cancer (IBC) is a rare and highly aggressive form of breast cancer characterized by rapid onset, inflammatory changes in the breast, and a poor prognosis. Its management requires a multidisciplinary approach due to its aggressive nature and diagnostic challenges. Objective: The objective of this study is to comprehensively evaluate the management of Inflammatory Breast Cancer at the Cancer Centre, CMH Dhaka, and Border Guard Bangladesh (BGB) Hospital in Dhaka, focusing on clinical presentation, diagnostic methods, treatment strategies, and patient outcomes. Methods: This prospective study included patients who presented with Inflammatory Breast Cancer at CMH, Dhaka and BGB Hospital Dhaka Cancer Centre over a specified period from June 2021 to June 2023. Results: The study revealed that IBC continues to pose significant diagnostic challenges, often leading to delayed treatment initiation. Among the studies, a total of N=13 patients were managed within the past two years, and the prognosis remained unfavorable. Even after receiving neoadjuvant chemotherapy, a patient passed away from the illness within half a year of being diagnosed. Physical examinations consistently identified signs of inflammation, with skin changes in 54% of cases and palpable masses in 85%. Hormone receptor status revealed 23% of patients with triple- negative breast cancer (TNBC), while 31% were HER2 positive. Molecular classification showed that 31% belonged to the Luminal type-A category, and 31% were HER2 positive. Conclusion: Inflammatory Breast Cancer management at CMH, Dhaka and BGB Hospital, Dhaka, underscores the critical need for early detection and a multidisciplinary approach. The aggressive nature of IBC, coupled with diagnostic uncertainties, highlights the importance of a high clinical suspicion. To improve patient outcomes, timely and comprehensive management by a multidisciplinary team is imperative. This study highlights the complexity of IBC and underscores the importance of early intervention and holistic patient care despite the challenges faced.

Inflammatory breast cancer: As surgical oncologists, what can we do?

Breast cancer surgery is the primary treatment for early-stage breast cancer. However, inflammatory breast cancer (IBC), with its specific presentation characterized by skin invasion, is unfit for primary surgery. According to the different guidelines, the management of IBC is trimodal with the coordination of oncologists, surgeons, and radiation therapists. Advances in breast cancer imaging and the development of more targeted therapies make new challenges for this aggressive cancer. This chapter aims to provide an update on the role of surgery in IBC. Radical surgery is still considered the standard surgical treatment in IBC. Some authors suggest a conservative surgery in patients with a clinical response to chemotherapy without affecting survival. For lymph node surgery, the sentinel lymph node biopsy (SLNB) is not feasible in IBC patients, according to the existing studies. However, prospective studies on SLNB are needed to verify its reliability after chemotherapy for a specific group of patients. In the metastatic IBC, surgery can be considered if there is a good response after chemotherapy or for uncontrolled symptoms. Existing studies showed that surgery may impact survival for these patients. Prospective studies are mandatory to optimize IBC management, considering factors such as tumor's molecular profile.

Radiation for inflammatory breast cancer: Updates.

Inflammatory breast cancer (IBC) is a diagnosis based on a constellation of clinical features of edema (peau d'orange) of a third or more of the skin of the breast with a palpable border and a rapid onset of breast erythema. Incidence of IBC has increased over time, although it still makes up only 1-4% of all breast cancer diagnoses. Despite recent encouraging data on clinical outcomes, the published local-regional control rates remain consistently lower than the rates for non-IBC. In this review, we focus on radiotherapy, provide a framework for multi-disciplinary care for IBC, describe local-regional treatment techniques for IBC; highlight new directions in the management of patients with metastatic IBC and offer an introduction to future directions regarding the optimal treatment and management of IBC.

Contemporary surgical management of inflammatory breast cancer: a narrative review.

The purpose of this review is to outline the surgical management of inflammatory breast cancer (IBC) including the clinical decision making, operative approach and current controversies. IBC is a rare and aggressive form of breast cancer. Trimodality therapy consisting of neoadjuvant therapy, modified radical mastectomy (MRM) and radiation therapy improves survival and is the recommended course of treatment. Advancements in systemic therapy and de-escalation strategies in non-IBC have accelerated discussions regarding several aspects of care in IBC including feasibility of de-escalation of surgical care, timing of reconstruction and the role of surgery in de novo stage IV disease. We discuss the evidence to support the surgical approach and decision-making in this rare disease. We reviewed existing literature using multiple electronic databases and clinical consensus guidelines to identify historical and current publications addressing current management recommendations and clinical controversies in IBC. Breast conserving surgery (BCS), skin- or nipple-sparing mastectomy should not be performed in IBC as surgical resection to negative margins results in improved locoregional recurrence rates. Level I and II axillary lymph node dissection should be performed regardless of response to therapy and initial nodal status. Reconstruction should be delayed and contralateral prophylactic mastectomy (CPM) is discouraged in IBC. Surgery may be considered for de novo stage IV IBC patients who demonstrate durable response to neoadjuvant therapy to improve local-regional control.

"Why and What" for the optimal management of inflammatory breast cancer.

"Why and What" for the optimal management of inflammatory breast cancer.

How should radiation be done for inflammatory breast cancer patients?-a narrative review of modern literature.

This review highlights the considerations of the radiation oncologist when managing patients with inflammatory breast cancer (IBC) as well as the radiation oncologist's role as a member of the multi-disciplinary team. IBC makes up only 1-4% of all breast cancer diagnoses but incidence is increasing. IBC is diagnosed based on a constellation of clinical features, including the rapid onset of breast erythema and edema (peau d'orange) of one-third or more of the skin of the breast and with a palpable border to the edema. Most published IBC local-regional control rates are consistently lower than those observed in non-IBC, which the highlights the need for deliberate treatment techniques to maximize clinical outcomes. For this narrative review, we discuss the principles of radiation target delineation and dose escalation; highlight new findings in the local-regional management of IBC; provide a critical evaluation of the recent literature evaluating local-regional treatment of IBC; and offer a brief introduction to possible future directions regarding the optimal treatment and management of IBC based on our institutional experience. IBC is an aggressive type of breast cancer that warrants multi-disciplinary care from breast surgical, medical, and radiation oncology. Several strategies exist to enhance the effect of radiation therapy (RT) on local-regional control, including hyperfractionation, use of bolus, increased total RT dose, and radiosensitizers, which are currently being tested in randomized trials. With an individualized patient approach, local-regional control rates are improving for IBC.

ASO Visual Abstract: Current Surgical Management of Inflammatory Breast Cancer

ASO Visual Abstract: Current Surgical Management of Inflammatory Breast Cancer

Current Surgical Management of Inflammatory Breast Cancer.

Inflammatory breast cancer (IBC) is a rare and aggressive breast cancer characterized by erythema and edema of at least one-third of the breast. The diagnosis remains a clinical one. Standard of care involves trimodality therapy with anthracycline-based neoadjuvant chemotherapy and human epidermal growth factor receptor 2 (HER2)-directed therapy if HER2 positive, followed by modified radical mastectomy and post-mastectomy radiation therapy to the chest wall in addition to regional nodal basins including supraclavicular and internal mammary nodes. Current evidence does not support de-escalation of surgical therapy in the breast and axilla in IBC, and positive surgical margins have been associated with worse outcomes. Furthermore, sentinel node biopsy for axillary staging has a high false negative rate prohibiting its use in IBC. Delayed reconstruction is recommended for IBC due to a high recurrence rate and a potential for delay in adjuvant therapy. Contralateral prophylactic mastectomy may be considered at the time of delayed reconstruction. In this paper, we discuss available evidence and controversies in the current surgical management of patients with IBC.

Sentinel Lymph Node Biopsy May Prevent Unnecessary Axillary Dissection in Patients with Inflammatory Breast Cancer Who Respond to Systemic Treatment

Background and Objectives: Inflammatory breast cancer (IBC) is a rare and aggressive breast cancer treated up-front with systemic treatment. Both breast-conserving surgery and sentinel lymph node biopsy (SLNB) are controversial issues in the management of IBC. In this study, we aimed to assess the feasibility of SLNB in pathologically proven node-positive IBC patients. Methods: All patients with a histopathological diagnosis of IBC and biopsy-proven metastatic axillary lymph nodes underwent systemic treatment. Patients with a complete clinical response in the axilla who underwent SLNB followed by standard axillary dissection were analyzed. Results: The study consisted of 25 female patients. The identification rate (IR) and the false negativity rate (FNR) were 17/25 and 2/10, respectively. Overall, 9/25 and 7/25 of patients had a complete pathological response (pCR) in the breast and axilla after systemic treatment, respectively. Although the pCR in the axilla was 2/4 in nonluminal HER2-positive patients, the highest IR 4/4 and the lowest FNR 0/2 were determined in these patients. In triple-negative patients, however, the IR was 2/4 and the FNR was found to be 0/2. Conclusions: SLNB may be considered in selected axilla-downstaged IBC patients including patients with a pCR with HER2-positive and triple-negative tumors. Axillary dissection may be, therefore, omitted in those with negative SLNs.

Targeting the cancer microenvironment: inflammatory breast cancer management

Targeting the cancer microenvironment: inflammatory breast cancer management

Perspectives on Inflammatory Breast Cancer (IBC) Research, Clinical Management and Community Engagement from the Duke IBC Consortium.

Inflammatory breast cancer (IBC) is an understudied and aggressive form of breast cancer with a poor prognosis, accounting for 2-6% of new breast cancer diagnoses but 10% of all breast cancer-related deaths in the United States. Currently there are no therapeutic regimens developed specifically for IBC, and it is critical to recognize that all aspects of treating IBC - including staging, diagnosis, and therapy - are vastly different than other breast cancers. In December 2014, under the umbrella of an interdisciplinary initiative supported by the Duke School of Medicine, researchers, clinicians, research administrators, and patient advocates formed the Duke Consortium for IBC to address the needs of patients in North Carolina (an ethnically and economically diverse state with 100 counties) and across the Southeastern United States. The primary goal of this group is to translate research into action and improve both awareness and patient care through collaborations with local, national and international IBC programs. The consortium held its inaugural meeting on Feb 28, 2018, which also marked Rare Disease Day and convened national research experts, clinicians, patients, advocates, government representatives, foundation leaders, staff, and trainees. The meeting focused on new developments and challenges in the clinical management of IBC, research challenges and opportunities, and an interactive session to garner input from patients, advocates, and community partners that would inform a strategic plan toward continuing improvements in IBC patient care, research, and education.

Abstract 2397: Intracellular cholesterol regulates the DNA damage response in inflammatory breast cancer

Abstract Purpose: Inflammatory breast cancer (IBC) is a highly aggressive form of breast cancer, and patients with IBC remain at high risk of locoregional recurrence after radiotherapy. We previously demonstrated that depleting intracellular cholesterol induces radiosensitivity in IBC cells in vitro, and that IBC patients with high levels of high-density lipoprotein (HDL) and those taking a statin, which inhibits de novo cholesterol biosynthesis, have improved locoregional control after radiotherapy. These results suggest that targeting cholesterol metabolism may improve the radiotherapeutic management of IBC. Here, we aimed to understand the molecular mechanism(s) linking cholesterol metabolism and radiation-induced DNA damage and DNA repair and to evaluate statin pharmacotherapy as a DNA repair inhibitor and radiotherapeutic adjunct in an in vivo pre-clinical model of IBC. Methods: KPL4, SUM149, SUM190, and IBC3 IBC cell lines were used to examine the effect(s) of simvastatin and human serum lipoproteins on radiation-induced DNA damage induction, DNA damage signaling, DNA damage-associated G1, intra-S, and G2/M cell cycle checkpoint activation, and DNA double strand break (DSB) repair by homologous recombination (HR) and non-homologous end joining (NHEJ). Results: We have generated multiple IBC cells lines with an integrated Traffic Light Reporter (TLR) that is capable of measuring HR and NHEJ, and demonstrate that depletion of intracellular cholesterol abrogates HR-mediated repair of DNA DSBs. We also show that intracellular cholesterol has pleiotropic effects on cell cycle distribution and DNA damage-associated cell cycle checkpoints. We also report a novel polycistronic dual bioluminescence reporter system that can robustly visualize and quantitate DNA DSB induction and repair in vitro and in vivo. Conclusions: Cholesterol is an important determinant of intrinsic radiosensitivity in IBC, and appears to regulate repair of radiation-induced DNA DSBs. Targeting cholesterol metabolism is a potential strategy to overcome IBC radioresistance and improve the prognosis for this aggressive disease. Citation Format: Shane R. Stecklein, Adam R. Wolfe, Bisrat G. Debeb, Richard A. Larson, Wendy A. Woodward. Intracellular cholesterol regulates the DNA damage response in inflammatory breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 2397.

Inflammatory Breast Cancer: A Literature Review.

The multidisciplinary management of inflammatory breast cancer (IBC), which is the most aggressive form of breast cancer due to its rapid proliferation, has changed over the past three decades thanks to advances in medical treatments that represent the basis of treatment, without eliminating the use of locoregional treatments including surgery and radiotherapy in the localized stages. The molecular profile determination of IBC allows the orientation towards new targeted therapeutic strategies with an impact on survival.

International Consensus on the Clinical Management of Inflammatory Breast Cancer from the Morgan Welch Inflammatory Breast Cancer Research Program 10th Anniversary Conference.

National and international experts in inflammatory breast cancer (IBC) from high-volume centers treating IBC recently convened at the 10th Anniversary Conference of the Morgan Welch Inflammatory Breast Cancer Research Program at The University of Texas MD Anderson Cancer Center in Houston Texas. A consensus on the clinical management of patients with IBC was discussed, summarized, and subsequently reviewed. All participants at the conference (patients, advocates, researchers, trainees, and clinicians) were queried using the MDRing electronic survey on key management issues. A summary of the expert consensus and participant voting is presented. Bilateral breast and nodal evaluation, breast magnetic resonance imaging, positron emission tomography/computed tomography, and medical photographs were endorsed as optimal. Neoadjuvant systemic therapy, modified radical mastectomy and level I and II ipsilateral axillary node dissection, post-mastectomy radiotherapy, adjuvant targeted therapy and hormonal therapy as indicated, and delayed reconstruction were agreed-upon fundamental premises of standard non-protocol-based treatment for IBC. Consideration for local-regional therapy in de novo stage IV IBC was endorsed to provide local control whenever feasible. Variation across centers and special circumstances were discussed.

Inflammatory Breast Cancer Outcomes in a Contemporary Series.

Evidence on the management of inflammatory breast cancer (IBC) is limited. This study investigated factors influencing IBC treatment outcomes such as event-free survival (EFS) and overall survival (OS). Data were collected from 173 patients with stage III non-IBC and 17 patients with IBC diagnosed at the Keck Medical Center and Los Angeles County and University of Southern California (LAC+USC) Medical Center. Cox proportional hazard regression evaluated associations between variables significant for EFS and OS. On multivariate analysis, negative estrogen receptor (ER)status [hazard ratio (HR)=1.88, 95% confidence interval (CI)=1.11-3.18, p<0.06) and lack of postoperative radiation treatment (HR=2.07, 95% CI=1.03-4.15, p<0.04) were significant for poorer EFS. High Scarff-Bloom-Richardson (SBR) score (HR=2.24, 95% CI=0.79-6.36, p<0.13) and lack of postoperative radiation treatment to the breast (HR=4.39, 95% CI=0.39-49.55, p<0.23) were associated with lower rates of OS. The diagnosis of IBC has a significantly worse prognosis. Receipt of post-mastectomy radiation therapy was a significant predictor of better EFS and OS.

Abstract P4-02-08: MRI changes in breast skin following preoperative therapy for inflammatory breast cancer (IBC)

Abstract Purpose: Standard treatment for IBC includes preoperative systemic therapy (PST), followed by mastectomy (M) and adjuvant radiation (R). Determining the optimal sequencing of M and R after PST may be difficult when clinical changes suggest residual disease within breast skin. With the goal of selecting appropriate patients (pts) for M prior to R, we correlated pathologic disease response in breast skin with changes in skin thickness and enhancement determined by MRI. Methods: An IRB approved database of IBC pts evaluated at Dana Farber Cancer Institute (DFCI) from 1997-2013 was used for retrospective analysis. 40 pts met criteria: confirmed diagnosis of IBC, completed PST followed by M without preoperative R. Baseline and post-PST breast MRI imaging was reviewed. Using the ACR BI-RADS lexicon, we recorded skin thickness, qualitative enhancement and kinetic analysis using computer-aided detection post-processing software. Findings were correlated with pathologic response in skin found at M. Results: MRI showed baseline skin thickening in all 40 pts (median 6mm, range 3-13mm). Although 34 (85%) had persistent skin thickening post-PST (median 4 mm, range &amp;lt;3-13 mm), there was a significant overall reduction in skin thickness (p&amp;lt;0.001); median decrease =2mm, range 1-7mm. MRI showed qualitative skin enhancement at baseline in 39/40 pts. 29 (73%) had medium/fast initial phase kinetics: 25 persistent delayed phase kinetics, 2 wash-out, 2 plateau. 20 pts had residual qualitative skin enhancement post-PST; 11 pts (28%) had medium/fast initial phase kinetics, all persistent delayed kinetics. The decrease in skin thickness was significantly greater among the 19 pts achieving resolution of skin enhancement post-PST compared with the decrease in skin thickness among the 20 pts with residual skin enhancement (p=0.02). 8 pts (20%) had residual tumor within the skin at M. All 8 pts had thicker skin on post-PST MRI (median 5 mm, range 3-13mm) compared with pts without residual disease in the skin (median 3.5mm, range &amp;lt;3-11 mm). Qualitative skin enhancement post-PST was seen in 63% of pts (5/8) with residual skin disease compared with 47% of pts (15/32) without disease. Conclusion: Although IBC pts have skin thickening demonstrated by MRI at baseline, there is a statistically significant reduction in the skin thickness following successful PST. This correlates with a reduction in enhancement of the skin shown by MRI imaging. More substantial and persistent skin thickening with enhancement was seen in the setting of residual dermal lymphatic involvement following the completion of PST, though this study is too small to detect any significant correlation. Since an accurate assessment of residual disease in breast skin is vital in determining the optimal sequencing of M and R following PST in IBC pts, MRI evaluation of skin thickness and enhancement may be a useful tool to predict residual disease and guide surgical management of IBC. Citation Format: Yeh E, Rives A, Guo H, Regan M, Birdwell R, Nakhlis F, Bellon J, Warren L, Hirshfield-Bartek J, Jacene H, Dominici L, Overmoyer B. MRI changes in breast skin following preoperative therapy for inflammatory breast cancer (IBC). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-02-08.

A69 - Inflammatory breast cancer management: a single centre experience

A69 - Inflammatory breast cancer management: a single centre experience