From OncoLog, November 2006, Vol. 51, No. 11

Targeting Inflammatory Breast Cancer

Inflammatory breast cancer (IBC), an extremely rare, fast-growing, and lethal form of breast cancer that can spread in just a few weeks, is often mistaken for something other than breast cancer, such as a rash or infection. All aspects of treating IBC—including staging, diagnosis, and therapy—are vastly different from other breast cancers.

IBC is more likely to be misdiagnosed, and ultimately diagnosed after the disease has metastasized, said Massimo Cristofanilli, M.D., associate professor in the Department of Breast Medical Oncology at M. D. Anderson Cancer Center.

The extremely aggressive disease represents 1% to 2% of newly diagnosed invasive breast cancers in the United States. Unlike other breast cancers that present as a lump, IBC’s symptoms are unique and include redness, swelling, and warmth in the breast; skin that is reddish, purple, or bruised; and skin that has ridges and/or appears pitted like an orange. Other symptoms can include burning, aching, or tenderness, an increase in breast size, and an inverted nipple.

The median age range of IBC patients is between 45 and 55 years old. The 5-year median survival rate is approximately 40%. “There are a number of reasons for such a disappointing survival outcome—a delay in diagnosis because it is often mistaken for a rash, the lack of expertise in treating IBC because it is so rare, and the relative resistance the disease has to standard chemotherapeutic agents,” said Dr. Cristofanilli.

Detecting and treating IBC

“Because IBC usually does not occur in the form of a lump and instead spreads throughout the breast tissue, it is very difficult to detect the disease with a mammogram,” said Dr. Cristofanilli. Magnetic resonance imaging and biopsies generally cannot accurately diagnose IBC either. However, surgical biopsy and positron emission tomography (PET) can be used. In the near future, PET scans could be one of the most important diagnostic/staging tests for IBC. “Though still under study, we have found that with PET scans, we can see more of the IBC, including lymph nodes far from the breast, which will allow us to determine if there is metastatic disease at the time of diagnosis,” said Dr. Cristofanilli.

Current treatment for IBC includes chemotherapy, surgery, radiation, targeted therapy, and/or hormonal therapy when appropriate. In early preliminary studies, the hormonal therapy lapatinib (Tykerb) has shown promise for IBC patients whose tumors express the HER-2 gene. M. D. Anderson is using drugs like trastuzumab (Herceptin) or lapatinib in a subset of IBC patients that have the HER-2 gene. Researchers are focused on finding ways to eliminate microscopic disease to prolong survival in IBC patients. “We hope to conduct future lapatinib studies in this clinic and determine if the drug works by itself, with chemotherapy, or with several chemotherapies,” Dr. Cristofanilli said.

A new clinic especially for IBC

In an effort to better understand the complexities of IBC and to improve the outcomes for women with the disease, M. D. Anderson has established the first clinic in the world dedicated to the treatment and research of IBC. Exploring new treatments for IBC will be a priority of the clinic, said Dr. Cristofanilli.

Under the co-direction of Dr. Cristofanilli and Thomas Buchholz, M.D., a professor in the Department of Radiation Oncology, the clinic plans to see 60 to 80 new patients annually, more than double the number it currently treats.

“The primary goal of both the clinic and the research program is to finally understand why this disease is different, why it is so resistant to treatment, and ultimately, to develop therapies that improve the well-being of women with this very rare form of breast cancer,” said Dr. Cristofanilli.

“The scientific community needs a comprehensive clinic and research program in order to make significant progress in the overall prognosis of women with IBC. There are so few cases of this disease, and they are scattered throughout the world. We will collect appropriate serum and tissue, look at gene expression, and gather other pertinent biological information in hopes of finally developing treatment guidelines for IBC,” said Dr. Cristofanilli.

For more information on this topic or for questions about M. D. Anderson’s treatments, programs, or services, call askMDAnderson at (877) MDA-6789.

TOP

Home/Current Issue | Previous Issues | Articles by Topic | Patient Education
About Oncolog | Contact OncoLog | Sign Up for E-mail Alerts

©2009 The University of Texas M. D. Anderson Cancer Center
1515 Holcombe Blvd., Houston, TX 77030
1-877-MDA-6789 (USA) / 1-713-792-3245  
 Patient Referral    Legal Statements    Privacy Policy