Sequence of therapies not associated with improved survival from inflammatory breast cancer

June 19, 2006

The order in which patients with inflammatory breast cancer undergo different types of treatment does not appear to be associated with improved survival rates, which remain poor, according to a report in the June issue of Archives of Surgery, one of the JAMA/Archives journals.

Approximately 2.5 in 100,000 women develop inflammatory breast cancer, which is characterized by rapid tumor growth, early metastasis (cancer spreading to other parts of the body) and poor survival rates as compared with other forms of breast cancer, according to background information in the article. Combining surgery, chemotherapy, radiation therapy and endocrine therapy has improved survival rates and become the standard of care for patients with this disease. Some recent studies have suggested that performing surgery before beginning other types of treatment may improve survival rates.

Rory L. Smoot, M.D., and colleagues at Mayo Clinic College of Medicine, Rochester, Minn., reviewed data from the records of 156 consecutive patients (155 female, one male) who were treated there for inflammatory breast cancer between 1985 and 2003. Twenty-eight patients with cancer that had already metastasized at their first visit were excluded from the study. The remaining 128 patients had an average age of 53 years, and 57 percent of women were post-menopausal.

By 2003, 51 patients (40 percent) survived and 77 (60 percent) died; five-year survival rates were 42 percent with 21 percent surviving disease-free. Of the 128 patients without metastatic disease, 22 (17 percent) had surgery as their initial treatment and 106 (83 percent) underwent chemotherapy first. Although some analyses showed that patients who had surgery first lived longer than those who did not, the results were not significant when other factors were taken into account. In addition, certain aspects of each patients' prognosis likely influenced her and her physician's treatment decisions, making outcomes difficult to compare, the researchers write.

"The treatment strategy described herein (neoadjuvant chemotherapy, mastectomy, adjuvant chemotherapy and radiotherapy, followed by endocrine therapy if receptors are positive) has significantly increased overall survival compared with single-modality or dual-modality regimens, but overall survival remains low compared with that associated with noninflammatory breast cancer," the authors conclude. "Although the combined-modality regimen clearly provides the best outcome for patients with inflammatory breast cancer, further research is necessary to delineate subsets of patients who may benefit from alterations in the approach to improve survival from this aggressive disease."
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(Arch Surg. 2006;141:567-573. Available pre-embargo to the media at www.jamamedia.org.)

For more information, contact JAMA/Archives Media Relations at 312/464-JAMA (5262) or e-mail mediarelations@jama-archives.org.

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