Strategies to improve long-term outcome in stage IIIB inflammatory breast cancer: multimodality treatment including dose-intensive induction and high-dose chemotherapy.
Inflammatory breast cancer (IBC) is a rare clinicopathologic entity with a poor prognosis, lagging far behind any other form of nonmetastatic breast cancer. Since the advent of systemic chemotherapy over 35 years ago, only minimal progress has been made in long-term outcome. Although multiple randomized trials of high-dose chemotherapy and autologous progenitor cell transplantation (ASCT) for the treatment of breast cancer have yielded disappointing results, these data are not necessarily relevant to IBC, a distinct clinical and pathologic entity. Therefore, the optimal multimodality therapy for IBC is not well established, and remains unsatisfactory. We treated 21 women with nonmetastatic IBC with a multimodality strategy including high-dose melphalan (Mel)/etoposide and ASCT. The treatment was overall tolerated with acceptable morbidity, and no post-ASCT 100-day mortality. With a median potential follow-up of approximately 8 years, the estimated progression-free survival (PFS), event-free survival (EFS), and overall survival (OS) at 6 years from on-study date are: 67%, 55%, and 69%, respectively. These results from a small phase II study are among the most promising of mature outcome data for IBC. They strongly suggest, along with results of several already published phase II trials, that ASCT could play a significant role in the first line treatment of IBC.
Sportès
Claude
C
Experimental Transplantation & Immunology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland 20892-1203, USA. csportes@mail.nih.gov
Steinberg
Seth M
SM
Liewehr
David J
DJ
Gea-Banacloche
Juan
J
Danforth
David N
DN
Avila
Daniele N
DN
Bryant
Kelly E
KE
Krumlauf
Michael C
MC
Fowler
Daniel H
DH
Pavletic
Steven
S
Hardy
Nancy M
NM
Bishop
Michael R
MR
Gress
Ronald E
RE
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D005047:Etoposide / Q000627:therapeutic use; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods; D006801:Humans; D007249:Inflammation; D008558:Melphalan / Q000627:therapeutic use; D008875:Middle Aged; D012074:Remission Induction / Q000379:methods; D016019:Survival Analysis; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D005047:Etoposide; D008558:Melphalan