From the Guidelines
The treatment for inflammatory breast cancer should involve a multimodal approach, starting with systemic chemotherapy, followed by surgery and radiation therapy, as recommended by the most recent guidelines 1. The initial treatment typically involves neoadjuvant chemotherapy with anthracycline-based regimens combined with taxanes, administered for 4-6 months to reduce tumor size and control the disease.
- The choice of chemotherapy regimen may depend on the tumor's biomarker expression, such as HER2 status, with targeted therapy with trastuzumab recommended for HER2-positive tumors 1.
- After chemotherapy, a modified radical mastectomy is usually performed, as breast-conserving surgery is generally not recommended due to the diffuse nature of this cancer.
- Following surgery, radiation therapy to the chest wall and regional lymph nodes is delivered, typically 50-60 Gy over 5-6 weeks, as recommended by the guidelines 1.
- Additional treatments may include hormone therapy for hormone receptor-positive disease, continued for 5-10 years.
- Immediate reconstruction is generally not recommended in patients with inflammatory breast cancer, due to the high risk of recurrence and the need for postoperative radiotherapy 1. The comprehensive treatment plan aims to control both local disease and potential microscopic spread throughout the body, with the goal of improving morbidity, mortality, and quality of life outcomes for patients with inflammatory breast cancer.
- The treatment approach should be individualized, taking into account the patient's tumor characteristics, performance status, and preferences, as well as the potential risks and benefits of each treatment option 1.
From the FDA Drug Label
1 INDICATIONS AND USAGE
1.1 Adjuvant Breast Cancer Ogivri is indicated in adults for adjuvant treatment of HER2 overexpressing node positive or node negative (ER/PR negative or with one high risk feature [see Clinical Studies (14. 1)]) breast cancer as part of a treatment regimen consisting of doxorubicin, cyclophosphamide, and either paclitaxel or docetaxel as part of a treatment regimen with docetaxel and carboplatin as a single agent following multi-modality anthracycline based therapy.
- 2 Metastatic Breast Cancer Ogivri is indicated in adults: In combination with paclitaxel for first-line treatment of HER2-overexpressing metastatic breast cancer As a single agent for treatment of HER2-overexpressing breast cancer in patients who have received one or more chemotherapy regimens for metastatic disease
The treatment for inflammatory breast cancer is not directly mentioned in the provided drug label. However, it does mention the treatment for HER2-overexpressing breast cancer, which may be relevant in some cases of inflammatory breast cancer.
- The drug label indicates that trastuzumab (IV) is used for the treatment of HER2-overexpressing breast cancer.
- It is used in combination with other drugs such as paclitaxel, doxorubicin, cyclophosphamide, docetaxel, and carboplatin.
- The label also mentions that patients should be selected for therapy based on an FDA-approved companion diagnostic for a trastuzumab product 2.
From the Research
Treatment Overview
The treatment for inflammatory breast cancer (IBC) typically involves a combination of therapies, including:
- Chemotherapy: anthracyclines and taxanes are commonly used as the mainstay of treatment 3
- Surgery: may be performed after neoadjuvant chemotherapy to remove the tumor 3, 4
- Radiation therapy: plays a major role in locoregional treatment, often used in combination with surgery 3, 4
Systemic Therapies
Systemic therapies, such as targeted therapies, have shown promise in improving responses and survival rates for IBC patients 5. These therapies may include:
- Angiogenic modulators
- Farnesyl transferase inhibitors
- p53 modulators 3
Multidisciplinary Management
The management of IBC involves a multidisciplinary approach, combining systemic therapy, surgery, and radiation therapy 4. This approach has evolved over the years, with ongoing research aimed at improving treatment outcomes.
Molecular Biology and Future Directions
Recent studies have focused on understanding the molecular biology of IBC, identifying potential targets for therapy 6, 7. The tumor microenvironment and inflammation have been identified as key factors in IBC pathogenesis and progression, suggesting that anti-inflammatory therapy and immunotherapy may be promising areas of investigation 7.