According to the National Cancer Institute (2012), “Inflammatory breast cancer is treated first with systemic chemotherapy to help shrink the tumor, then with surgery to remove the tumor, followed by radiation therapy. This approach to treatment is called a multimodal approach. Studies have found that women with inflammatory breast cancer who are treated with a multi-modal approach have better responses to therapy and longer survival. Treatments used in a multimodal approach may include those described below.
- Neoadjuvant chemotherapy: This type of chemotherapy is given before surgery and usually includes both anthracycline and taxane drugs. At least six cycles of neoadjuvant chemotherapy given over the course of 4 to 6 months before attempting to remove the tumor has been recommended, unless the disease continues to progress during this time and doctors decide that surgery should not be delayed.
- Targeted therapy: This type of treatment may be used if a woman’s biopsy samples show that her cancer cells have a tumor marker that can be targeted with specific drugs. For example, inflammatory breast cancers often produce greater than normal amounts of the HER2 protein, which means they may respond positively to drugs, such as trastuzumab (Herceptin), that target this protein. Anti-HER2 therapy can be given as part of neoadjuvant therapy and after surgery (adjuvant therapy). Studies have shown that women with inflammatory breast cancer who received trastuzumab in addition to chemotherapy have better responses to treatment and better survival.
- Hormone therapy: If a woman’s biopsy samples show that her cancer cells contain hormone receptors, hormone therapy is another treatment option. For example, breast cancer cells that have estrogen receptors depend on the female hormone estrogen to promote their growth. Drugs such as tamoxifen, which prevent estrogen from binding to its receptor, and aromatase inhibitors such as letrozole, which block the body’s ability to make estrogen, can cause estrogen-dependent cancer cells to stop growing and die.
- Surgery: The standard surgery for inflammatory breast cancer is a modified radical mastectomy. This surgery involves removal of the entire affected breast and most or all of the lymph nodes under the adjacent arm. Often, the lining over the underlying chest muscles is also removed, but the chest muscles are preserved. Sometimes, however, the smaller chest muscle (pectoralis minor) may be removed, too.
- Radiation therapy: Post-mastectomy radiation therapy to the chest wall under the breast that was removed is a standard part of multi-modal therapy for inflammatory breast cancer. If a woman received trastuzumab before surgery, she may continue to receive it during postoperative radiation therapy. If breast reconstruction is planned, the sequencing of the radiation therapy and reconstructive surgery may be influenced by the method of breast reconstruction used. If a breast implant is to be used, the preferred approach is to delay radiation therapy until after the reconstructive surgery. If a woman’s own tissues are going to be used in breast reconstruction, it is preferable to delay reconstructive surgery until after the radiation therapy has been completed.
- Adjuvant therapy: Adjuvant systemic therapy may be given after surgery to reduce the chance of cancer recurrence. This therapy may include additional chemotherapy, antihormonal therapy, targeted therapy (such as trastuzumab), or some combination of these treatments.
- Supportive/palliative care: The goal of supportive/palliative care is to improve the quality of life of patients who have a serious or life-threatening disease, such as cancer, and to provide support to their loved ones.”*
*Citation: “Inflammatory Breast Cancer Questions and Answers Sheet.” National Cancer Institute at the National Institutes of Health. www.cancer.gov, 2012. Retrieved from Web 17 May 2012. http://www.cancer.gov/cancertopics/factsheet/Sites-Types/IBC.