Triple Negative Inflammatory Breast Cancer

Treatment Of Inflammatory Breast Cancer

Inflammatory breast cancer is an uncommon type of invasive breast cancer that typically makes the skin on the breast look red and feel warm. It also may give the breast skin a thick, pitted appearance that looks a lot like an orange peel. These changes are caused by cancer cells blocking lymph vessels in the skin.

Because inflammatory breast cancer has reached these lymph vessels and has caused changes in the skin, it is considered to be at least a stage III breast cancer when it is diagnosed. IBC that has spread to other parts of the body is considered stage IV. These cancers typically grow quickly and can be challenging to treat.

Regardless of the stage of the cancer, participation in a clinical trial of new treatments for IBC is also a good option because IBC is rare, has a poor prognosis , and these studies often allow access to drugs not available for standard treatment.

What Are Breast Cancer Subtypes And Why Do They Matter

Your breast cancer subtype is one factor healthcare providers take into account when theyre deciding how to treat your cancer. Thats because not all cancer treatments are successful with all breast cancer subtypes.

Providers look at your cancer cells to identify subtypes. Specifically, they look for molecules on your cells surfaces. These molecules, called receptors, are built to order so only certain substances can climb on and start affecting what your cells do.

Breast cancer cells receptors are open to estrogen and progesterone. Understanding if your breast cancer cells have receptors and if theyre housing hormones helps providers determine how your breast cancer might spread and what treatment might be most effective.

The other type of breast cancer that has another receptor is called her-2 neu. This receptor makes the cells more active, but allows healthcare providers to treat the cancer with specific medicines that target her-2 proteins. If your breast cancer doesnt have her-2 neu and hormone receptors, its called triple negative.

Identification Of Tnbc Subtypes

In our previous study , we reproduced the algorithm of Lehmann et al. and extracted the centroids of the seven TNBC subtypes based on the training data . By using that same method, we assigned the 88 TNBC samples in the World IBC Consortium dataset to a TNBC subtype with the use of both our approximated and Lehmanns gene signatures. We used the highest Pearson correlation and lowest P value as the criteria to determine to which subtype a specific sample belonged. We constructed two 7×2 contingency tables based on the gene signatures we obtained and the original ones in Lehmann et al. The Fisher Exact test was applied to compare the TN-IBC and TN-non-IBC subtypes.

To determine the power of detecting an extreme shift, we set the margins of the 7×2 table of subtypes by IBC status, assigned a 0 to the first cell, randomly allocated the rest, and computed the Fisher test P value. We repeated this process 500 times and then moved to the next cell . Our overall power was 3,304/7,000=0.472.

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Survival Rates For Triple

Triple-negative breast cancer is considered an aggressive cancer because it grows quickly, is more likely to have spread at the time its found, and is more likely to come back after treatment than other types of breast cancer. The outlook is generally not as good as it is for other types of breast cancer.

Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time after they were diagnosed. They cant tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful.

Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they cant predict what will happen in any particular persons case. These statistics can be confusing and may lead you to have more questions. Talk with your doctor about how these numbers may apply to you, as they are familiar with your situation.

How Is Tnbc Diagnosed

Imaging tests are usually the first tests done:

• Mammography, the most common screening tool for breast cancer, uses X-rays to take images of the breast and can uncover tumors that may be too small to feel.
• MRI uses a magnet, radio waves and a computer to make detailed images of the breast with a much greater resolution than a mammogram offers.

The next step is a biopsy to remove a sample of suspicious cells from the breast to analyze them. Techniques include:

• Surgical biopsy

The appropriate type of biopsy for you depends on factors such as the size and location of the tumor. You may also have a biopsy of your underarm lymph nodes at the same time to see if any cancer is there.

Breast cancer treatment: The care you need is one call away

Your multidisciplinary team will work with you to develop a personalized plan to treat your breast cancer in a way that fits your individual needs and goals.

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Causes Of Triple Negative Breast Cancer

The risk factors for triple negative breast cancer are not clear. Some breast cancers depend on hormones to grow. These can be linked with risk factors to do with hormones and having children. But triple negative breast cancer does not seem to share these risk factors.

Most women with triple negative breast cancer have no strong history of breast cancer in their family . But some women with triple negative breast cancer have an altered BRCA1 gene. This will have been inherited from a parent.

An altered BRCA 1 gene can cause breast cancer to run in families. Most breast cancers caused by BRCA1 are triple negative.

If you have triple negative breast cancer, you may be offered genetic testing. This is even if you do not have a family history of breast cancer. Your cancer doctor or breast care nurse can explain more about this to you.

The tests are the same as for any type of breast cancer. You usually have a:

• Mammogram

  A mammogram is an x-ray of the breast.

• Ultrasound scan

  An ultrasound scan uses sound waves to produce a picture of the breast tissue and the lymph nodes in the armpit.

• Breast biopsy

  When you have a breast biopsy, your cancer doctor or breast care nurse takes small samples of cells or tissue from your breast. The samples are looked at under a microscope to check for cancer cells. They also do other tests to find out if the cells have receptors for hormones, or for HER2.

See also

The staging and grading is the same as for other types of breast cancer.

What Does Triple Negative Mean In Terms Of Breast Cancer

Normal breast cells have receptors that respond to hormones such as estrogen and progesterone, which allows them to grow and regress in response to the hormone level. Hormone receptors may or may not be present in breast cancer. About two-thirds of breast cancers are positive and contain these receptors like normal breast cells do. These are less aggressive cancers that are less likely to need chemo and are often treated with hormone therapy and surgery. Radiation may or may not be needed.

HER2/neu , is a protein molecule that has a role in cell proliferation in normal cells. In some breast cancers, this protein is overly produced or positive. For HER2-positive tumors, there a specific medication that targets this protein.

Triple-negative breast cancers are not positive for estrogen receptors, progesterone receptors or HER2 protein. Since these targets are absent in triple-negative breast cancer, chemotherapy is needed, Sun says. Triple-negative breast cancer is often very sensitive to chemotherapy, which, despite the side effects, is an effective treatment that can save lives. Because this is an aggressive cancer, treatment is aggressive also. But there are several ways we can address it.

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Characteristics Of Inflammatory Breast Cancer:

• Inflammatory breast cancer tends to be diagnosed at younger ages
• Inflammatory breast cancer is rare out of all the kinds of breast cancer diagnosed in the United States, only 1 5% of them will be inflammatory.
• Inflammatory breast cancer is more common and diagnosed at younger ages in Black women than in white women.
• Inflammatory breast tumors usually are hormone receptor negative, which means they cannot be treated with hormone therapies, such as tamoxifen, that interfere with the growth of cancer cells fueled by estrogen.
• Inflammatory breast cancer is more common in obese women than in women of normal weight.
• Inflammatory breast cancer can occur in men, but usually at an older age than in women.

Playing An Active Role

You play an active role in making treatment decisions by understanding your breast cancer diagnosis, your treatment options and possible side effects.

Together, you and your health care provider can choose treatments that fit your values and lifestyle.

Learn more about factors that affect treatment options.

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Breast Cancer Subtypes In Ibc

Assessment of hormone receptor status and HER2 expression is part of the standard evaluations that drive therapeutic choices in breast cancer patients . In IBCs, several studies have been conducted in order to identify any significant difference compared to nIBC. The incidence of HR-positive subtype is lower in IBC than in nIBC, while HER2-positive and triple-negative tumors are higher represented in IBC, being associated with worse outcome . On the other hand, another study reported a comparable incidence of triple negative subtype between IBC and nIBC tumors . Moreover, according to a retrospective analysis on 593 IBC patients, HR+/HER2, HR+/HER2+, HR/HER2+, and triple-negative tumors were 231 , 98 , 112 , and 152 , respectively . When assessed by gene expression profiling, molecular subtypes showed similar distributions in IBCs as compared to nIBCs. Indeed, Van Laere et al. reported that all subtypes are represented in IBC . Notably, a lower incidence of luminal A tumors and a higher of HER2+ tumors were observed.

Triple-negative and HR+/HER2 IBCs presented significantly worse survival compared with HR+/HER2+ or HR/HER2+ subtypes .

Re: Newly Diagnosed Triple Negative

Hi CoddfishThat is interesting about the Targit -IORT, I noticed a lot of women who had it went on to have sessions of the usual radiotherapy afterwards.I hope you don’t get these side effects but I got joint pain from the cumulative effects of the filgrastim injections and found a daily tablet of Loratadine hayfever tablet, ibuleve gel and paracetamol rather than ibuprofen worked quite well. I later got a terrible rash from the Paclitaxol and this time coped with Hayleve which I could take every 4hrs and some Anthisan cream. Wishing you all the best in your treatment. x

Hi @Cheirologist

@when I enquired further via one of the hospitals that did Targit-IORT, they dont recommend it for TNBC as they feel whole breast radiotherapy is needed. I did have surgery first as my tumour was smaller. There wasnt anything in the sampled lymph nodes but there was some vascular invasion from the tumour so I am now on chemo. 2 EC in, 2 to go. Then 12 weeks of Paclitaxel, followed by 5 days of radiotherapy. I am also having 6 monthly Zometa for 3 years.

Good luck with your treatment.

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Patient Cohorts And Ge Data

Three institutions contributed to the World IBC Consortium dataset: The University of Texas MD Anderson Cancer Center, Houston, TX General Hospital Sint-Augustinus, Antwerp, Wilrijk, Belgium and Institut Paoli-Calmettes, Marseille, France . The dataset also includes 252 non-IBC patients. We obtained clinical data and GE profiles, as well as breast cancer samples, for 389 patients from these three institutions. All patients gave written informed consent for voluntary participation, and this study was approved by the institutional review boards of all three participating centers. Samples were stored according to each institutions criteria, as described in the supplemental information . IBC was defined according to the consensus diagnostic criteria published by Dawood et al. . In total, 137 IBC patients and 252 non-IBC patients were in the World IBC Consortium database.

All patients were treated with use of a multidisciplinary approach according to the guidelines of each center. Most patients were treated with neoadjuvant chemotherapy, with the addition of hormone therapy in patients with ER expression, and with the addition of trastuzumab in patients with HER2 amplification. In TNBC patients, 21 of 27 IBC patients and 29 of 44 non-IBC patients received neoadjuvant chemotherapy. Neoadjuvant regimens based on anthracycline and taxanes, such as T-FAC , were given at the treating physicians discretion.

Table 1 Characteristics of patients with TNBC

The Toxicity Effects And Time Kinetics Of Treatment With Am9928

First, the toxicity of AM9928 on TNBC cells were analyzed. TNBC cells include the highly invasive MDA-MB-231 and the brain- seeking variant MDA-MB-BrM2 cells. The following doses were examined: 250, 500 or 1000 nM, for durations of 72 h. No significant toxicity of AM9928 was observed on the tested cells.

Figure 2

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Who Is Most Likely To Have Tnbc

Triple negative breast cancer appears more frequently in women age 40 and younger than in older women. Black and Latina women are more likely to develop TNBC than white women. Women who have the gene change BRCA1 are more likely to develop TNBC than other women. When the BRCA1 gene mutates, it stops preventing cancer and appears to make your bodys cells more vulnerable to cancer.

Toward Precision Medicine In Inflammatory Breast Cancer

Giulia Viale1,2, Antonio Marra1,2, Giuseppe Curigliano1,2, Carmen Criscitiello1

1 Division of Early Drug Development for Innovative Therapy, IEO , European Institute of Oncology IRCCS , Department of Oncology and Haematology , , Italy

Contributions: Conception and design: C Criscitiello, G Viale Administrative support: C Criscitiello, G Curigliano Provision of study materials or patients: All authors Collection and assembly of data: C Criscitiello, G Viale, A Marra Data analysis and interpretation: C Criscitiello, G Viale, A Marra Manuscript writing: All authors Final approval of manuscript: All authors.

Correspondence to:

Keywords: Inflammatory breast cancer molecular subtypes activated pathways targeted agents

Submitted Apr 01, 2019. Accepted for publication Apr 30, 2019.

doi: 10.21037/tcr.2019.05.04

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What Is The Treatment For Triple Negative Breast Cancer

Healthcare providers and researchers are making significant progress on TNBC treatments. Recent clinical trials are testing new combinations of drugs and new approaches to existing treatments. Some existing treatments are:

• Chemotherapy: Providers might combine chemotherapy and surgery, with chemotherapy being used to shrink your tumor before surgery or after surgery to kill cancer cells throughout your body.
• Surgery: This could be a lumpectomy to remove an individual lump, or a mastectomy to remove an entire breast. Providers then perform a sentinel node biopsy or axillary node surgery to look for signs your breast cancer has spread to your lymph nodes.
• Radiation therapy: Post-surgery radiation therapy helps reduce the chances your cancer will return or recur.
• Immunotherapy: This treatment stimulates your immune system to produce more cancer-fighting cells or help healthy cells identify and attack cancer cells. Immunotherapy can be added to chemotherapy to before surgery to shrink the tumor. You might also receive immunotherapy for about a year after your surgery and post-surgery radiation therapy.

Treating Stage Iii Inflammatory Breast Cancer

IBC that has not spread outside the breast or to nearby lymph nodes is stage III. Treatment usually starts with chemotherapy to try to shrink the tumor. If the cancer is HER2-positive, targeted therapy is given along with the chemo. This is typically followed by surgery to remove the cancer. Radiation therapy often follows surgery. Sometimes, more chemo may be given after surgery but before radiation. If the cancer is hormone receptor-positive , hormone therapy is given as well . Combining these treatments has improved survival significantly over the years.

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What Is The Prognosis Of Patients With Inflammatory Breast Cancer

The prognosis, or likely outcome, for a patient diagnosed with cancer is often viewed as the chance that the cancer will be treated successfully and that the patient will recover completely. Many factors can influence a cancer patients prognosis, including the type and location of the cancer, the stage of the disease, the patients age and overall general health, and the extent to which the patients disease responds to treatment.

Because inflammatory breast cancer usually develops quickly and spreads aggressively to other parts of the body, women diagnosed with this disease, in general, do not survive as long as women diagnosed with other types of breast cancer.

It is important to keep in mind, however, that survival statistics are based on large numbers of patients and that an individual womans prognosis could be better or worse, depending on her tumor characteristics and medical history. Women who have inflammatory breast cancer are encouraged to talk with their doctor about their prognosis, given their particular situation.

Ongoing research, especially at the molecular level, will increase our understanding of how inflammatory breast cancer begins and progresses. This knowledge should enable the development of new treatments and more accurate prognoses for women diagnosed with this disease. It is important, therefore, that women who are diagnosed with inflammatory breast cancer talk with their doctor about the option of participating in a clinical trial.