Treatments : standard of care for inflammatory breast cancer

The therapeutic tools are the same as for other forms of breast cancer. What changes with inflammatory breast cancer is the order of treatments, the type of operation proposed and the size of the area to be irradiated.

Here is the standard of care for stage 3 inflammatory breast cancer:

  • Neoadjuvant chemotherapy;
  • Surgery – Modified radical mastectomy;
  • Radiotherapy

Chemotherapy

Inflammatory breast cancer is considered inoperable right away because it generally develops in layers and not in a well-defined tumor. The goal of neoadjuvant chemotherapy, before surgery, is to reduce the size of the tumor and kill the cancer cells that may have spread elsewhere.

Various combinations of drugs can be used, but the following combinations seem to be the most common:

  • AC (doxorubicin (adriamycin) and cyclophosphamide) or FEC (cyclophosphamide, epirubicin and 5-fluorouracil) or EC (cyclophosphamide and epirubicin)
  • Taxol (paclitaxel) or Taxotere (docetaxel).

If the HER2 protein is overexpressed, targeted therapy (Herceptin) will be added to the chemotherapy.

If cancer does not regress with chemotherapy, surgery can not be done. It is then possible to continue chemotherapy and/or to perform neoadjuvant radiation therapy.

Surgery

Since inflammatory breast cancer affects a large part of the breast as well as the skin and the risk of recurrence is high, the only recommended surgery is a modified radical mastectomy (thus removing the whole breast as well as the axillary lymph nodes located on the affected side). Subcutaneous mastectomy, where the skin is spared, is not recommended because the skin is affected. Immediate breast reconstruction should not be performed for various reasons that I will present later.

Radiation therapy

Radiation therapy is recommended regardless of the response to chemotherapy in order to target possible cancer cells that would not have been removed during surgery. The targeted areas are the chest wall as well as the axillary and supraclavicular lymph nodes on the affected side.

If hormone receptors are present, hormone therapy will be administered after radiation therapy.

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