Survival outcomes seen with neoadjuvant chemotherapy in the management of locally advanced inflammatory breast cancer (IBC) versus matched controls
Kai CC Johnson,
Michael Grimm,
Jasmine Sukumar,
Patrick M. Schnell,
Ko Un Park,
Daniel G. Stover,
Sachin R. Jhawar,
Margaret Gatti-Mays,
Robert Wesolowski,
Nicole Williams,
Sagar Sardesai,
Ashley Pariser,
Preeti Sudheendra,
Gary Tozbikian,
Bhuvaneswari Ramaswamy,
Dureti Doto,
Mathew A. Cherian
Affiliations
Kai CC Johnson
Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
Michael Grimm
Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
Jasmine Sukumar
Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
Patrick M. Schnell
Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
Ko Un Park
Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA; Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH, USA
Daniel G. Stover
Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
Sachin R. Jhawar
Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
Margaret Gatti-Mays
Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
Robert Wesolowski
Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
Nicole Williams
Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
Sagar Sardesai
Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
Ashley Pariser
Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
Preeti Sudheendra
Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
Gary Tozbikian
Department of Pathology, The Ohio State University, Columbus, OH, USA
Bhuvaneswari Ramaswamy
Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
Dureti Doto
Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
Mathew A. Cherian
Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA; Corresponding author. Division of Medical Oncology, The Ohio State University Wexner Medical Center, Biomedical Research Tower, Room 888, 460 W 12th Ave, Columbus, OH, 43210, USA.
Inflammatory breast cancer (IBC) poses an ongoing challenge as rates of disease recurrence and mortality remain high compared to stage-matched controls. However, frontline therapy has evolved through the years, including the widespread use of neoadjuvant chemotherapy (NAC) given the prognostic importance of pathologic complete response (pCR). Due to these sweeping changes, we need new data to assess current recurrence and survival outcomes for locally advanced IBC in the context of matched non-inflammatory controls. We conducted a retrospective analysis of institutional IBC data from 2010 to 2016 with the primary objective of comparing overall survival (OS), relapse-free survival (RFS), and distant relapse-free survival (DRFS). We matched IBC patients to non-inflammatory controls based on age, receptor status, tumor grade, clinical stage, and receipt of prior NAC. Secondary objectives included assessing pCR rates and identifying prognostic factors. Among NAC recipients, we observed similar pCR rates (47.6 % vs. 49.4 %, p = 0.88) between IBC (n = 84) and matched non-IBC (n = 81) cohorts. However, we noted a significant worsening of OS (p = 0.0001), RFS (p = 0.0001), and DRFS (p = 0.001) in the IBC group. Specifically, 5-year OS in the IBC cohort was 58.9 % vs. 86.7 % for matched controls (p = 0.0003). Older age was a weak negative predictor for OS (HR 1.03, p = 0.001) and RFS (HR 1.02, p = 0.01). For DRFS, older age was also a weak negative predictor (HR 1.02, p = 0.02), whereas the use of NAC was a positive predictor (HR 0.47, p = 0.02). Despite no clear difference in pCR, survival outcomes remain poor for IBC compared to matched non-inflammatory controls.
