Inflammatory breast cancer is a unique and uncommon type of breast cancer. Inflammatory cancers typically appear swollen, warm, and cause induration of the breast. This occurs because cancer cells may block the lymph vessels in the skin of the breast. Biopsies often reveal that patients have lymphatic invasion beneath the skin by the cancer.

A variety of factors ultimately influence a patient's decision to receive treatment of cancer. The purpose of receiving cancer treatment may be to improve symptoms through local control of the cancer, increase a patient's chance of cure, or prolong a patient's survival. The potential benefits of receiving cancer treatment must be carefully balanced with the potential risks of receiving cancer treatment.

The following is a general overview of the treatment of inflammatory breast cancer. Circumstances unique to your situation and prognostic factors of your cancer may ultimately influence how these general treatment principles are applied. The information on this Web site is intended to help educate you about your treatment options and to facilitate a mutual or shared decision-making process with your treating cancer physician.

Most new treatments are developed in clinical trials. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. The development of more effective cancer treatments requires that new and innovative therapies be evaluated with cancer patients. Participation in a clinical trial may offer access to better treatments and advance the existing knowledge about treatment of this cancer. Clinical trials are available for most stages of cancer. Patients who are interested in participating in a clinical trial should discuss the risks and benefits of clinical trials with their physician. To ensure that you are receiving the optimal treatment of your cancer, it is important to stay informed and follow the cancer news in order to learn about new treatments and the results of clinical trials.

Inflammatory breast cancer generally grows rapidly and the cancer cells often spread to other parts of the body. Treatment for inflammatory breast cancer usually involves multi-modality therapy consisting of local treatment to remove or destroy the cancer in the breast and systemic treatment to kill cancer cells that may have already spread to other parts of the body. Systemic treatment (chemotherapy, hormonal therapy) is generally given before local treatment with surgery and/or radiation therapy. The usual sequence of treatment involves chemotherapy followed by surgery, radiation therapy, further chemotherapy, and hormonal therapy. With this approach, approximately 30% of women survive 5 years without cancer recurrence. The use of chemotherapy and local-regional radiotherapy has reduced the risk of cancer progressing at or near the site of origin, but the majority of patients experience cancer recurrence at distant sites.

High-dose chemotherapy and autologous stem cell transplantation has been incorporated into the overall treatment of women with inflammatory breast cancer. Several small clinical trials were published in 1998-99 that reported the results of incorporating high-dose chemotherapy into the overall treatment strategy of patients with inflammatory breast cancer. In general, patients were treated with a sequence of low-dose induction chemotherapy followed by high-dose chemotherapy and mastectomy, radiation and hormonal treatment with Nolvadex® (tamoxifen). Some doctors have performed mastectomy after induction chemotherapy instead of after high-dose chemotherapy. Approximately 64% of patients are reported to survive without recurrence of their cancer 2.5 to 3 years from treatment. Recently, doctors from France utilizing this treatment regimen have reported 57% cancer-free survival rates 5 years from treatment, with no patients relapsing after 3 years.

Researchers compared the results of intensive chemotherapy and high-dose chemotherapy approaches in patients with inflammatory breast cancer. Four years from treatment, 76% of patients treated with high-dose chemotherapy were alive without cancer recurrence, compared to 58% of patients treated with non-high-dose chemotherapy. Since inflammatory breast cancer only accounts for 1-4% of all breast cancers, large clinical studies comparing one treatment strategy to another have not been and are unlikely to ever be performed.

Strategies to Improve Treatment of Inflammatory Breast Cancer

The main reason patients with inflammatory breast cancer fail treatment is relapse. Relapse of inflammatory breast cancer occurs locally in the breast and/or distantly. Distant relapse occurs because current chemotherapy is unable to kill all of the cancer cells in the patient. Local relapse occurs because the surgery and radiation were unable to destroy the cancer cells in the breast. Doctors are performing clinical trials designed to improve the treatment of breast cancer that include the following approaches alone or in combination:

Increased Dose Intensity: Since more treatment kills more cancer cells, increasing the intensity of treatment delivered by utilizing high doses of anti-cancer therapies or by delivering multiple cycles of high-dose therapy is one strategy to improve cure rates.

Monoclonal Antibodies: Monoclonal antibodies are a treatment that can locate cancer cells and kill them directly and avoid harming the normal cells. The monoclonal antibody Herceptin® (trastuzumab) has been approved for the treatment of advanced breast cancer and can be administered alone or with certain chemotherapy. Herceptin® recognizes and binds to a protein called HER2, which is found on the surface of some normal cells and plays a role in regulating cell growth. Herceptin® attaches to the HER2 protein to slow growth of breast cancer cells and possibly stimulate the immune system to more effectively attack the cancer. Herceptin® is currently being evaluated in adjuvant clinical studies in breast cancer.

Minimal Residual Disease: Following cancer treatment, patients often achieve a complete remission, (complete disappearance of the cancer). Unfortunately, many patients in remission still experience a relapse of their cancer. This is because not all of the cancer cells were destroyed. Doctors refer to this as a state of "minimal residual disease". Many doctors believe that applying additional cancer treatments when only a few cancer cells remain represents the best opportunity to prevent the cancer from returning. In addition to monoclonal antibodies, several centers are investigating vaccines and other biologic modifiers that stimulate the body's immune system to kill breast cancer cells. Newer biologics agents are in the developmental phase.

Improve Local Cancer Control: More intensive local treatment with different doses or schedules of radiation and evaluating the timing and sequence of radiation and surgery in the overall treatment plan are being evaluated in clinical trials in order to decrease the risk of local cancer recurrences.