Prognostic Indicators and Survival in Patients With Stage IIIB Inflammatory Breast Carcinoma After Dose-Intense Chemotherapy

• Published in: Journal of clinical oncology Vol. 22; no. 10; pp. 1839 - 1848
• Main Authors: SOMLO, George, FRANKEL, Paul, TWARDOWSKI, Przemyslaw, WEITZEL, Jeffrey, ALVARNAS, Joseph, KOGUT, Neil, SCHRIBER, Jeffrey, FERMIN, Eleanor, YUN YEN, DAMON, Lloyd, DOROSHOW, James H, CHOW, Warren, LEONG, Lucille, MARGOLIN, Kim, MORGAN, Robert JR, SHIBATA, Stephen, PEIGUO CHU, FORMAN, Stephen, LIM, Dean
• Format: Journal Article
• Language: English
• Published: Baltimore, MD American Society of Clinical Oncology 15.05.2004; Lippincott Williams & Wilkins
• Subjects: Adult; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Breast Neoplasms - mortality; Breast Neoplasms - pathology; Breast Neoplasms - therapy; California; Combined Modality Therapy; Disease-Free Survival; Female; Hematopoietic Stem Cell Transplantation; Humans; Medical Records; Medical sciences; Middle Aged; Neoplasm Metastasis; Neoplasm Staging; Prognosis; Retrospective Studies; Survival Analysis; Treatment Outcome; Tumors; California; Antineoplastic agent; Human; Carcinoma; Prognosis; Inflammation; Malignant tumor; Survival; Indicator; Chemotherapy; Cancerology; Treatment; Mammary gland; Dose
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/JCO.2004.10.147

To improve treatment outcome for patients presenting with inflammatory breast cancer (IBC), we have sequentially developed and tested single and tandem dose-intense chemotherapy regimens (DICT). Tumor- and treatment-related factors were analyzed to generate a prognostic model. Between May 1989 and April 2002, 120 patients received conventional-dose chemotherapy, surgery, and sequentially developed single- or tandem-cycle DICT. Disease- and treatment-specific features were subjected to univariate and multivariate analysis to correlate with outcome. At a median follow-up of 61 months (range, 21 to 161 months), estimated 5-year relapse-free survival (RFS) and overall survival (OS) were 44% (95% CI, 34% to 53%) and 64% (95% CI, 55% to 73%), respectively. In an age-adjusted multivariate analysis, RFS was better in patients with estrogen receptor (ER)/progesterone receptor (PR)-positive tumors (P =.002), for patients with fewer than four involved axillary nodes before DICT (P =.01), and in patients treated with radiation therapy (P =.001) and tandem DICT (P =.049). OS was improved in patients with ER/PR-positive tumors (P =.002), in those with fewer than four involved axillary nodes before DICT (P =.03), and in patients treated with radiation therapy (P =.002). This retrospective analysis suggests that either single or tandem DICT can be administered safely and may benefit selected patients with stage IIIB IBC. Those with receptor-negative IBC and with four or more involved axillary nodes before DICT need improved neoadjuvant and postadjuvant intensification therapy. A prospective randomized trial of single versus tandem DICT would be required to confirm the potential benefit of tandem DICT in the setting of IBC.