Treatment of Inflammatory Breast Cancer

Inflammatory breast cancer (IBC) is an uncommon type of invasive breast cancer that typically makes the skin on the breast look red and feel warm. It also may give the breast skin a thick, pitted appearance that looks a lot like an orange peel. These changes are caused by cancer cells blocking lymph vessels in the skin.

Because inflammatory breast cancer has reached these vessels and has caused changes in the skin, it is considered to be at least a stage III breast cancer. IBC that has spread to other parts of the body is considered stage IV. These cancers typically grow quickly and can be challenging to treat.

Treating stage III inflammatory breast cancer

IBC that has not spread outside the breast or nearby lymph nodes is stage III. Treatment usually starts with chemotherapy (chemo) to try to shrink the tumor. If the cancer is HER2-positive, targeted therapy is given along with the chemo. This is typically followed by surgery (mastectomy and lymph node dissection) to remove the cancer. Radiation therapy often follows surgery. Sometimes, more chemo may be given after surgery but before radiation. If the cancer is hormone receptor-positive (estrogen or progesterone), hormone therapy is given as well (usually after all chemo has been given). Combining these treatments has improved survival significantly over the years.

Chemotherapy (possibly along with targeted therapy)

Chemo drugs enter the bloodstream and circulate throughout the body to reach and destroy cancer cells in almost all parts of the body, so chemo is considered a type of systemic therapy. It treats both the main tumor as well as any cancer cells that have broken off and spread to lymph nodes or other parts of the body.

Using chemo before surgery is called neoadjuvant or preoperative treatment. Most women with IBC will receive two types of chemo drugs (although not necessarily at the same time):

  • An anthracycline, such as doxorubicin (Adriamycin) or epirubicin (Ellence)
  • A taxane, such as paclitaxel (Taxol) or docetaxel (Taxotere)

Other chemo drugs may be used as well.

If the cancer is HER2-positive (the cancer cells make too much of a protein called HER2), the targeted therapy drug trastuzumab (Herceptin) is usually given, sometimes along with another targeted drug, pertuzumab (Perjeta). These drugs can lead to heart problems when given with an anthracycline, so one option is to give the anthracycline first (without trastuzumab or pertuzumab), followed by treatment with a taxane and trastuzumab (with or without pertuzumab).

Surgery and further treatments

If the cancer improves with chemo, surgery is typically the next step. The standard operation is a modified radical mastectomy, where the entire breast and the lymph nodes under the arm are removed. Because IBC affects so much of the breast and skin, breast-conserving surgery (partial mastectomy or lumpectomy) and skin-sparing mastectomy are not options. It isn’t clear that sentinel lymph node biopsy (where only one or a few nodes are removed) is reliable in IBC, so it is also not an option.

If the cancer does not respond to chemo (and the breast is still very swollen and red), surgery cannot be done. Either other chemo drugs will be tried, or the breast may be treated with radiation. Then if the cancer responds (the breast shrinks and is no longer red), surgery may be an option.

If breast radiation isn’t given before surgery, it is given after surgery, even if no cancer is thought to remain. This is called adjuvant radiation. It lowers the chance that the cancer will come back. Radiation is usually given 5 days a week for 6 weeks, but in some cases a more intense treatment (twice a day) can be used instead. Depending on how much tumor was found in the breast after surgery, radiation might be delayed until further chemo and/or targeted therapy (such as trastuzumab) is given. If breast reconstruction is to be done, it is usually delayed until after the radiation therapy that most often follows surgery.

Treatment after surgery often includes additional (adjuvant) systemic treatment. This can include chemo, hormone therapy (tamoxifen or an aromatase inhibitor) if the cancer cells have hormone receptors, and/or trastuzumab, pertuzumab or ado-trastuzumab emtansine if the cancer is HER2-positive.

Treating stage IV inflammatory breast cancer

Patients with metastatic (stage IV) IBC are treated with systemic therapy. This may include:

  • Chemotherapy
  • Hormonal therapy (if the cancer is hormone receptor-positive)
  • Targeted therapy with a drug that targets HER2 (if the cancer is HER2-positive)

One or more of these treatments might be used. Many times, a targeted drug is given along with chemotherapy or with hormone therapy. Surgery and radiation may also be options in certain situations.  See Treatment of Stage IV (Metastatic) Breast Cancer for more information.

Regardless of the stage of the cancer, participation in a clinical trial of new treatments for IBC is also a good option because IBC is rare, has a poor prognosis (outcome), and these studies often allow access to drugs not available for standard treatment.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as journalists, editors, and translators with extensive experience in medical writing.

Costa R, Santa-Maria CA, Rossi G, et al. Developmental therapeutics for inflammatory breast cancer: Biology and translational directions. Oncotarget. 2017;8(7):12417–12432.

Curigliano G. Inflammatory breast cancer and chest wall disease: The oncologist perspective. Eur J Surg Oncol. 2018 Aug;44(8):1142-1147.

Dawood S, Merajver SD, Viens P, et al. International expert panel on inflammatory breast cancer: Consensus statement for standardized diagnosis and treatment. Ann Oncol. 2011;22:515−523.

Henry NL, Shah PD, Haider I, Freer PE, Jagsi R, Sabel MS. Chapter 88: Cancer of the Breast. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, Pa: Elsevier; 2020.

Jagsi R, King TA, Lehman C, Morrow M, Harris JR, Burstein HJ. Chapter 79: Malignant Tumors of the Breast. In: DeVita VT, Lawrence TS, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2019.

Menta A, Fouad TM, Lucci A, Le-Petross H, Stauder MC, Woodward WA, Ueno NT, Lim B. Inflammatory Breast Cancer: What to Know About This Unique, Aggressive Breast Cancer. Surg Clin North Am. 2018 Aug;98(4):787-800.

National Cancer Institute. Inflammatory Breast Cancer. 2016. Accessed at https://www.cancer.gov/types/breast/ibc-fact-sheet on July 23, 2019.

National Comprehensive Cancer Network (NCCN). Practice Guidelines in Oncology: Breast Cancer. Version 2.2019. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf on August 8, 2019.

Raghav K, French JT, Ueno NT, et al. Inflammatory Breast Cancer: A Distinct Clinicopathological Entity Transcending Histological Distinction. PLoS One. 2016;11(1):e0145534. Published 2016 Jan 11. doi:10.1371/journal.pone.0145534.

Robertson FM, Bondy M, Yang W, et al. Inflammatory breast cancer: The disease, the biology, the treatment. CA Cancer J Clin. 2010;60:351-375.

Sinclair S, Swain SM. Primary systemic chemotherapy for inflammatory breast cancer. Cancer. 2010;116(11 Suppl):2821−2828.

Taghian A, El-Ghamry MN and Merajver SD. Inflammatory breast cancer: Clinical features and treatment. UpToDate website. https://www.uptodate.com/contents/inflammatory-breast-cancer-clinical-features-and-treatment. Last updated Sept 26, 2018. Accessed Aug 8, 2019.

Last Medical Review: September 18, 2019 Last Revised: September 18, 2019

 

 

American Cancer Society medical information is copyrighted material. For reprint requests, please see our Content Usage Policy.