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Separate Treatment Algorithm Created for Inflammatory Breast Cancer: Presented at NCCN

By Ed Susman

HOLLYWOOD, Fla. -- March 10, 2008 -- The first algorithm developed specifically for inflammatory breast cancer was unveiled here at the National Comprehensive Cancer Network (NCCN) 13th Annual Conference on Clinical Practice Guidelines and Quality Cancer Care.

The treatment pathway was written in response to criticism that this aggressive form of cancer requires its own treatment guidelines.

"We realised that inflammatory breast cancer is a distinct clinical-pathological entity," said Robert W. Carlson, MD, Professor of Medicine, Stanford University School of Medicine, Stanford, California.

Dr. Carlson, a member of the NCCN's Breast Cancer Guidelines Committee, said that inflammatory breast cancer is defined by dermal oedema of one-third or more of the breast, erythema of one-third or more of the breast, and a palpable border to the erythema. He added that the disease is usually associated with dermal lymphatic tumour.

The guidelines presented by Dr. Carlson suggest preoperative chemotherapy with an anthracycline alone or in combination with a taxane. "If the tumour is human epidermal growth factor receptor 2 (HER2)-positive, a trastuzumab-containing regimen should be offered, but it should not be offered concurrent with anthracycline administration," he stated.

If there is a response to the initial treatment, Dr. Carlson said, the guidelines recommend completing the planned chemotherapy and adding endocrine therapy if the tumour is oestrogen-receptor positive.

The algorithm suggests that women with inflammatory breast cancer complete 1 year of therapy on trastuzumab if the tumour proves to significantly overexpress the mutated HER2 gene.

Following the preoperative course, Dr. Carlson said the recommended surgery is a complete mastectomy and axillary dissection plus radiation therapy to the chest wall and supraclavicular nodes. The committee members disagreed over whether internal mammary nodes required radiation as well, if they were involved. After surgery is completed, the guidelines say that patients can opt for breast reconstruction.

If women with inflammatory breast cancer fail to respond to two rounds of preoperative treatment, they become eligible for individualised treatment, Dr. Carlson said.

Suggestions for a pretreatment work-up include a computer-assisted tomography scan of the chest and pelvis and an optional magnetic resonance imaging study and further chest imaging if pulmonary symptoms are present.


[Presentation title: Update: Breast Cancer Guidelines.]

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