Paclitaxel in the multimodality treatment for inflammatory breast carcinoma

Massimo Cristofanilli*, Aman U. Buzdar, Nour Sneige, Terry Smith, Barbara Wasaff, Nuhad Ibrahim, Daniel Booser, Edgardo Rivera, James L. Murray, Vicente Valero, Naoto Ueno, Eva S. Singletary, Kelly Hunt, Eric Strom, Marsha McNeese, Carol Stelling, Gabriel N. Hortobagyi

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

58 Scopus citations

Abstract

BACKGROUND. Inflammatory breast carcinoma (IBC) is a rare but aggressive form of breast carcinoma. Anthracycline-based regimens represent the standard of treatment for IBC. Reports of significant clinical activity of paclitaxel in metastatic breast carcinoma led the authors to investigate the role of this drug in the management of IBC. METHODS. Forty-four patients with IBC were enrolled between February 1994 and January 1998. The treatment plan consisted of induction chemotherapy (IC), mastectomy, adjuvant chemotherapy, and radiotherapy. Forty-two patients received IC with four cycles of fluorouracil, doxorubicin, and cyclophosphamide. If the clinical response was less than partial, patients were "crossed over" to paclitaxel before mastectomy. All patients received adjuvant paclitaxel. Patients unresectable after paclitaxel were offered high-dose chemotherapy with autologous peripheral blood progenitor cell support. RESULTS. Thirty-four patients (81%) achieved an objective clinical remission; 3 patients (7%) achieved a clinical complete remission, 31 (74%) a partial remission. Six patients (14%) achieved pathologic complete remission. Sixteen patients were treated with paclitaxel, 7 of them (44%) were able to undergo mastectomy. Median time to progression (TTP) was 22 months. Median overall survival (OS) was 46 months. Concordance between clinical and pathologic response was documented in only 8 patients (24%). No differences in TTP and OS compared with a historical group of 178 IBC patients treated with anthracycline-based regimens. CONCLUSIONS. Paclitaxel improves tumor resectability in anthracycline-refractory IBC. The impact of paclitaxel on the prognosis of IBC needs to be better evaluated in future trials using more dose-intensive schedules of administration. New imaging modalities may contribute to improve assessment of response to IC.

Original languageEnglish (US)
Pages (from-to)1775-1782
Number of pages8
JournalCancer
Volume92
Issue number7
DOIs
StatePublished - Oct 1 2001

Keywords

  • Anthracycline
  • High-dose induction chemotherapy with peripheral blood stem cell (PBSC) support
  • Inflammatory breast carcinoma
  • Neoadjuvant chemotherapy
  • Paclitaxel

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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