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 can 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 IIIB or IIIC. 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) to remove the cancer. Radiation therapy often follows surgery. In some cases, more chemo may be given after radiation. If the cancer is hormone receptor-positive (ER- or PR-positive), hormone therapy is given as well. 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 wherever they are, 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 have too much of a protein called HER2), the targeted therapy drug trastuzumab (Herceptin) is given as well, 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 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 and radiation often includes additional systemic treatment. This is known as adjuvant therapy and can include chemo, hormone therapy (tamoxifen or an aromatase inhibitor) if the cancer cells contain hormone receptors, and/or trastuzumab 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:
- 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. For more on the treatment of stage IV cancers, see our page about treating stage IV breast cancer.
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 so rare, and these studies often allow access to drugs not available for standard treatment. More information about clinical trials can be found in our clinical trials section.
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Last Medical Review: June 1, 2016 Last Revised: August 18, 2016
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