The National Cancer Institute explains, “Inflammatory breast cancer is generally 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 multimodal 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. Doctors generally recommend that at least six cycles of neoadjuvant chemotherapy be given over the course of 4 to 6 months before the tumor is removed, unless the disease continues to progress during this time and doctors decide that surgery should not be delayed.
- Targeted therapy: Inflammatory breast cancers often produce greater than normal amounts of the HER2 protein, which means that drugs such as trastuzumab (Herceptin) that target this protein may be used to treat them. Anti-HER2 therapy can be given both as part of neoadjuvant therapy and after surgery (adjuvant therapy).
- Hormone therapy: If the cells of a woman’s inflammatory breast cancer contain hormone receptors, hormone therapy is another treatment option. 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 multimodal therapy for inflammatory breast cancer. If a woman received trastuzumab before surgery, she may continue to receive it during postoperative radiation therapy. Breast reconstruction can be performed in women with inflammatory breast cancer, but, due to the importance of radiation therapy in treating this disease, experts generally recommend delayed reconstruction.
- Adjuvant therapy: Adjuvant systemic therapy may be given after surgery to reduce the chance of cancer recurrence. This therapy may include additional chemotherapy, hormone therapy, targeted therapy (such as trastuzumab), or some combination of these treatments.