Therapeutic strategies in inflammatory breast carcinoma based on prognostic factors

Abstract

Prognostic factors were identified in a group of 210 patients with inflammatory breast carcinoma (IBC) treated at Institut Gustave Roussy from 1976–1985 with three successive induction protocols: Group A (n = 91), 1976–1980, doxorubicin, vincristine, methotrexate (AVM); Group B (n = 79), 1980–1982, doxorubicin, vincristine, cyclophosphamide, methotrexate, 5-fluorouracil (AVCMF); Group C (n = 40), 1983–1985, AVCMF. Groups A and B received 3 courses of respective chemotherapy (Ct) followed by radiotherapy (Rt), 45 Gy to breast and nodes and 65–70 Gy to the tumor. Group C after the third Ct course received split courses of Rt to equivalent doses so there was no time lag between Ct courses. Ct from fourth to ninth courses was AVM in all groups. Hormonal therapy, radiocastration (pre and perimenopausal) or tamoxifen (postmenopausal) was given all patients. Clinical characteristics of age, menopausal status, castration, N status, and degree of clinical inflammation (limited to tumor area [PEV 2] or involving the entire breast [PEV 3]) were similar in all groups. Groups B and C had identical disease-free and overall survivals, superior to Group A (p = 0.005). In multi-variate analysis, AVCMF was one of the important prognostic factors together with PEV and N status. Three prognostic classes were identified: I (n = 66) — PEV 2 and N0-1 (relative risk (RR) of relapse 0.80X) where AVM was as effective as AVCMF; II (n = 126) — either N2-3 or PEV 3 (RR 1.10X) where AVCMF was statistically superior to AVM and reduced the RR significantly (p = 0.02); III (n = 18) — PEV 3 and N2-3 (RR 1.9X) where Ct increased neither DFS nor OS over a historical Rt-only group. For class III a much more aggressive Ct such as initial myeloablative therapy with bone marrow autograft may be useful, which may also further improve survival in chemosensitive class II.