Trimodality therapy may reduce locoregional recurrence in inflammatory breast cancer

Locoregional recurrence appeared rare among patients with breast cancer treated with trimodality therapy, according to study results presented at the American Society of Breast Surgeons Annual Meeting.

Inflammatory breast cancer is an aggressive and rare disease; however, relatively small patient sampling has led to limited research in treatment.

“As we know, historically, prognosis for inflammatory breast cancer has been very poor,” Kelly Rosso, MD, breast surgical oncology fellow at The University of Texas MD Anderson Cancer Center, said during a press conference. “Data from our own institution has failed to identify any significant improvement in survival from the 1970s to 2000s in this patient population. “However, we do know these trimodality therapies have improved survival,” Rosso added.

Researchers sought to identify risk factors associated with locoregional recurrence and survival in the era of triple modality therapy — comprised of neoadjuvant chemotherapy followed by mastectomy and postsurgical radiation. Researchers evaluated data from 114 patients (median age, 52 years) with inflammatory breast cancer who received aggressive trimodality therapy with curative intent to target locoregional disease. Sixty-three patients presented with N2 inflammatory breast cancer and 52 patients had N3 disease.

Median follow-up was 3.6 years.

Four patients experienced a locoregional recurrence during follow-up, including two patients who had limited clinical response to neoadjuvant therapy and two patients who had stable disease.

In addition, 25 patients died during follow-up, and 85 were censored at last follow-up.

Surgical margins appeared negative in 99% of patients.

Patients demonstrated a 3.19% (95% CI, 1.03-9.9) 2-year probability of local regional occurrence, and the 2-year probability of recurrence or distant metastases was 23.1% (95% CI, 16.43-43.28).

Five-year local/regional recurrence-free rate was 95.5%, and 5-year OS was 69.14%.

Competing risk analysis showed longer DFS was associated with patient age 65 years or older, HER-2–positive breast cancer, clinical stage IIIb disease, complete or partial radiologic response to neoadjuvant chemotherapy, pathologic complete response and lower nodal burden at presentation.

Rosso and colleagues noted that local/regional recurrence is extremely difficult to treat; however, metastatic disease is common among this patient population, and “progress means addressing the disease on all fronts.”

“Though longer follow-up is needed, aggressive surgical resection to negative margins in the frame of trimodality therapy with curative intent can lead to local regional recurrence rates that mirror noninflammatory breast cancer rates,” the researchers wrote. – by Kristie L. Kahl

Reference:

Rosso K. Improved locoregional control in a contemporary cohort of nonmetastatic inflammatory breast cancer patients undergoing surgery. Presented at: 18th Annual Meeting of the American Society of Breast Surgeons; April 26-30, 2017; Las Vegas.

Disclosures: Rosso reports no relevant financial disclosures.