Strategies to Improve Long Term Outcome in Stage IIIB Inflammatory Breast Cancer: Multimodality Treatment Including Dose-Intensive Induction and High-Dose Chemotherapy

摘要

Inflammatory Breast Cancer (IBC) is a rare clinico-pathological entity with a poor prognosis, lagging far behind any other form of non metastatic breast cancer. Since the advent of systemic chemotherapy over 35 years ago, only minimal progress has been made in long term outcome. Although multiple randomized trials of high-dose chemotherapy and autologous progenitor cell transplantation (ASCT) for the treatment of breast cancer have yielded disappointing results, these data are not necessarily relevant to IBC, a distinct clinical and pathological entity. Therefore, the optimal multimodality therapy for IBC is not well established and remains unsatisfactory. We treated 21 women with non metastatic IBC with a multi-modality strategy including high-dose melphalan / etoposide and ASCT. The treatment was overall tolerated with acceptable morbidity and no post ASCT 100-day mortality. With a median potential follow-up of approximately 8 years, the estimated PFS, EFS and OS at 6 years from on-study date are: 67%, 55% and 69% respectively. These results from a small phase II study are among the most promising of mature outcome data for IBC. They strongly suggest, along with results of several already published phase II trials, that ASCT could play a significant role in the first line treatment of IBC.