Abstract P1-24-07: Management trends and outcomes assessment for inflammatory breast cancer
Authors: Tran Jennifer , Valente Stephanie , Tu Chao , Kruse Megan 
Published: March 2022

Abstract
Introduction:Inflammatory breast cancer (IBC) is a rare and aggressive malignancy with a 5-year relapse free survival (RFS) previously reported to be approximately 40%. Standard treatment is tri-modality therapy consisting of neoadjuvant chemotherapy, surgery, and post-mastectomy radiation therapy. Certain systemic therapy recommendations for IBC are based on historical standards (such as use of anthracyclines for HER2+ breast cancer) that may no longer be favored in the real-world setting. Similarly, modified radical mastectomy without reconstruction has traditionally been the operation of choice for patients with IBC due to fears of margin positivity, risk of local recurrence, and the need for timely radiation. Studies have shown that reconstruction in breast cancer patients is associated with improved quality of life. Recognizing this benefit, the role of reconstruction in the setting of IBC is evolving. The purpose of this study is to characterize response to modern neoadjuvant chemotherapy, utilization of reconstruction, and survival outcomes for patients with IBC treated at our institution.Methods:A review of the Cleveland Clinic tumor registry was performed to identify patients with IBC between 2006-2019 who completed all 3 treatment modalities. Patient demographics, disease characteristics, treatment details, recurrence details, and date of last follow-up/death were recorded. Estimates of local and distal recurrence and RFS were created using Kaplan-Meier estimates. Results:A total of 68 patients with IBC were identified. Median duration of follow-up was 1.83 years (0.85-6.82) and median age was 55. Cases included 19 ER-/HER2-, 17 ER-/HER2+, 21 ER+/HER2-, and 11 ER+/HER2+. Pathologic complete response (pCR) was achieved in 27.9% of all patients with results by subtype as follows: ER-/HER2- 21.6%, ER-/HER2+ 41.2%, ER+/HER2- 19.0% and ER+/HER2+ 18.2%. The most common chemotherapy received by patients was AC-Taxol (52.9%). For HER2+ patients, 50% received AC-Taxol and 50% received non-anthracycline based chemotherapy. RFS was similar for ER+/HER2-, ER+/HER2+ and ER-/HER2+ patients, while ER-/HER2- patients had numerically worse RFS (58-65% vs 28% at 5 years) although this was not statistically significant (p=0.06). RFS was significantly better in patients who achieved pCR compared to those who had partial or no response to chemotherapy, regardless of biologic subtype (p=0.038).17 patients (24.3%) had immediate reconstruction (IR), 7 (10.0%) had delayed reconstruction (DR, &gt;1 year after initial treatment) and46 patients (65.7%) had no reconstruction (NR). The 5 year RFS for IR and NR was similar (52% vs 47%, respectively, p=0.5) although surgical complication rates were higher in the IR group (35.3% vs 6.3%, respectively, p= 0.012).Conclusion:With modern approach to treatment, patients with ER+/HER2+ breast cancer have encouraging survival outcomes compared to historical standards. Patients with ER-/HER2- IBC continue to have poor outcomes and are a group of patients in need of better systemic therapy options. In this cohort, patients who underwent IR did not see an appreciable difference in RFS compared to their non-reconstructed counterparts. Patients should have consultation with plastic surgery as initial surgical management is being discussed if reconstruction is desired. These data may be helpful in counseling patients on anticipated complications of surgery with reconstruction.
Citation Format: Jennifer Tran, Stephanie Valente, Chao Tu, Megan Kruse. Management trends and outcomes assessment for inflammatory breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-24-07.