Inflammatory breast cancer (IBC) is a rare and aggressive form of breast cancer, accounting for only 1-5% of breast cancer diagnoses but up to 10% of breast cancer deaths annually in the United States. In contrast to findings in non-IBC patients, prior studies of stage III IBC patients suggest that compared to other receptor subtypes, hormone receptor (HR) positivity is not a favorable prognostic factor. To compare overall survival between stage IV HR-positive IBC patients and their non-IBC counterparts in order to determine the prognostic value of HR positivity in stage IV IBC. We retrospectively examined 765 patients treated at MD Anderson Cancer Center and diagnosed between August 1987 and March 2012 with metastatic HR-positive breast cancer. Patient and tumor characteristics including HR quantitation were compared by IBC status. Differences between these subgroups were assessed using the chi-square test for categorical variables or a t-test for continuous measures. Compared to the to non-IBC cohort, stage IV HR-positive IBC patients were more likely to be PR-negative (65 vs. 77%, p=0.01). IBC patients were younger (median 48.5 vs. 55, p<0.001), more likely to have multiple metastases (48% vs. 38%, p=0.06), and less likely to have metastases to bone only (27% vs. 41%). Among all patients evaluated, those with visceral metastases had worse OS compared to those with bony metastases (2-year OS 75.1% vs 87.9%, p<0.001), as did those with multiple vs. single metastases (2-year OS 67.9% vs 88%, p<0.001). IBC patients had better performance status (100% vs. 93%, p=0.01) and were more likely to have definitive surgery (47% vs. 22%) and chemotherapy (89% vs. 45%, p<0.001). IBC patients were more likely to have received anthracyclines and taxanes (43% vs. 21% (p<0.001), 67% vs. 29% (p<0.001), respectively) and less likely to have first line hormonal therapy (6% vs. 49%, p<0.001). Overall survival at 2 years for HR-positive IBC vs. non-IBC patients was 76.9% vs. 81.0% (p=0.34). Exploring combined metrics of quantitative HR positivity, i.e., the sum, the difference, and the ratio of ER plus PR percentage, ER percentage (p=0.02), PR positivity and percentage (both p<0.001), HR sum (p<0.001) and ratio (p<0.001) but not difference (p=0.35) correlated to 2-year OS. PR positivity and qualitative PR percentage >9 correlated with a better 2-year OS (82.4% vs. 74.6% and 85% vs 72.7%, p<0.001). We found that while stage IV HR-positive IBC patients were more likely to have multiple metastases beyond the bone, they more commonly received chemotherapy rather than hormone-based regimens and achieved similar stage IV outcomes compared to non-IBC patients. These findings support our clinical practice offering trimodality therapy with systemic chemotherapy agents to HR-positive IBC patients.