How is inflammatory breast cancer treated?

The following is a brief summary of the treatment of inflammatory breast cancer (IBC). For more detailed information on the treatments discussed, see the treatment section of our document called Breast Cancer.

Stage III

Inflammatory breast cancer (IBC) that has not spread outside the breast or nearby lymph nodes is stage IIIB or IIIC. The usual treatment is chemotherapy (chemo) to try to shrink the tumor, followed by surgery to remove the cancer. Radiation follows surgery and then possibly more chemotherapy may be given after radiation. Combining these 3 types of treatment, starting with systemic chemo that reaches cells throughout the body, followed by local therapy (with surgery and radiation) has improved survival significantly over the years.

Chemo is the use of drugs for treating cancer. The drugs can be swallowed in pill form, or they can be injected by needle into a vein or muscle. Because the drugs enter the bloodstream and circulate throughout the body to reach and destroy cancer cells wherever they are, chemo is considered systemic therapy. It treats both the main tumor as well as any cancer cells that have broken off and spread to lymph nodes or distant organs.

Using chemo before surgery is called neoadjuvant treatment. The use of anthracyclines (such as doxorubicin/Adriamycin^® and epirubicin/Ellence^®) and taxanes (such as paclitaxel/Taxol^® and docetaxel/Taxotere^®) as chemo drugs for IBC have been shown to improve outcomes. Most women with IBC receive one of each type in some combination (although not always together—they may receive one followed by the other). Other chemo drugs may be used as well.

If the cancer is HER2-positive (the cancer cells have too much of a protein called HER2), the targeted therapy drug called trastuzumab (Herceptin^®) is given as well. This drug can lead to heart problems when given with an anthracycline, so the anthracycline may be given first (without trastuzumab), followed by treatment with a taxane and trastuzumab.

Participation in a clinical trial of IBC is also a good option because IBC is so rare and these studies can allow access to drugs not available for standard treatment. More information about clinical trials can be found in our document called Clinical Trials: What You Need To Know.

If the cancer improves with chemo, surgery is then performed (as long as the cancer has not spread). The standard operation is a modified radical mastectomy, where the entire breast and the lymph nodes under the arm are removed. Because IBC involves so much of the breast and skin, a lumpectomy or skin-sparing mastectomy is not a treatment option. Sentinel lymph node biopsy–where only one or a few nodes are removed–is not reliable in IBC, and so is also not an option. Breast reconstruction is best delayed until after the radiation that most often follows surgery. If, after chemo and surgery, no cancer is found in the breast or in the lymph nodes, the patient is far less likely to have the cancer recur (come back later).

If the cancer has not responded to chemo (and the breast is still very swollen and red), the breast may be treated with radiation before surgery. This sequence of treatment is not as common as surgery prior to radiation. Other chemo drugs may also be tried.

If breast radiation isn’t given before surgery, it is often given after surgery, even if no cancer is thought to remain. This, known as adjuvant radiation, lowers the chance that the cancer will come back. Radiotherapy is usually given 5 days a week for 6 weeks, but in some cases a more intense treatment (twice a day) can be used in this disease. Depending on how much tumor was found in the breast after surgery, radiation might be delayed until further chemo is given.

Treatment after surgery and radiation often includes additional systemic treatment. This is known as adjuvant therapy and can include chemo, hormonal therapy (tamoxifen or an aromatase inhibitor, if the cancer cells contain estrogen receptors), and/or trastuzumab (if the cancer is HER2-positive).

Stage IV

Patients with metastatic disease (Stage IV) are often treated with some type of systemic therapy. This may include chemo, hormonal therapy, and/or targeted therapy with trastuzumab (if the cancer is HER2-positive). The drug pertuzumab (Perjeta™) may be given along with trastuzumab.