Inflammatory Breast Cancer: Symptoms, Treatment & Research

How Serious is Inflammatory Breast Cancer?

Last time, we discussed the difficult nature of Triple Negative Breast Cancer. For this article, we will be taking a look at another type of breast cancer that can escape notice and invade at a concerning pace.

What is Inflammatory Breast Cancer?

Inflammatory Breast Cancer (IBC) was first described in medical literature in the early 19th century. It wasn’t until much later that it was formally recognized as a distinct subtype of breast cancer in the mid-20th century. The name “inflammatory” comes from its characteristic symptoms, which include redness, swelling, and warmth in the breast—features that mimic a breast infection rather than a tumor.

IBC is a rare but highly aggressive form of breast cancer that differs significantly from more common types. Unlike other breast cancers that typically present as lumps, IBC manifests with symptoms that resemble a severe yet normal infection. These commonalities in side effects often lead to misdiagnosis and delayed treatment. Exacerbating matters is how this type of breast cancer spreads rapidly, often reaching the lymph nodes and distant organs before it is detected.

How Rare is Inflammatory Breast Cancer?

Inflammatory Breast Cancer accounts for only 1-5% of all breast cancer cases, making it one of the rarest types of breast cancer. Despite its rarity, it is responsible for a disproportionately high number of breast cancer-related deaths due to its surging progression and resistance to standard treatments.

Early detection is very important for treating this cancer. IBC doesn’t stay in its Stage 0, Stage 1, or even Stage 2 state for long. If a patient has this combination of risk factors, as they would if they had those for Triple Negative Breast Cancer, it is highly encouraged that they increase the number of breast cancer screenings and tests that they have a year with an additional session or two:

• Gender: Primarily affects women, though men can also develop inflammatory breast cancer.
• Age: Inflammatory breast cancer is more common in younger women primarily between the ages of 30 to 50 compared to other breast cancers.
• BRCA1 or BRCA2 Mutations: As with other cancers, this is a high risk factor for IBC.
• Race: There is a higher incidence of IBC in the African American women demographic.
• Hormonal Factors: Early menarche, late menopause, and not having children or having them later in life are inflammatory breast cancer risk factors as well due to estrogen and progesterone exposure and fluctuations.
• Lifestyle: Studies suggest a link between obesity, elevated alcohol consumption, physical inactivity, and a higher likelihood of developing IBC.

What Are the Unique Symptoms and Challenges of Inflammatory Breast Cancer?

Symptoms of Inflammatory Breast Cancer

While other types of breast cancer don’t always form noticeable lump, even at later stages, inflammatory breast cancer has the dubious distinction of manifesting symptoms reminiscent of less perilous inflammatory infections. These are some of the early signs to look out for.

• Rapid onset of redness and swelling in one breast.
• A warm, painful, or tender breast, often mistaken for an infection.
• Thickened skin with an orange-peel texture (peau d’orange).
• Flattened or inverted nipple rather than an outward lump.
• Swollen lymph nodes under the arm or near the collarbone.

A telltale sign that a patient is dealing with IBC is that this redness and swelling will not meaningfully abate with traditional methods for dealing with infection states such as antibiotics.

Diagnostic Challenges

Because IBC lacks a distinct tumor mass, mammograms often fail to detect it early; MRIs and ultrasounds are often used to detect it better. Additionally, its resemblance to a breast infection (mastitis) can lead to misdiagnosis, causing dangerous delays in treatment.

Diagnostic methods include:

• Breast Biopsy: To confirm the presence of cancerous cells.
• MRI or Ultrasound: To detect abnormal tissue changes.
• PET or CT Scans: To check for metastasis, as IBC tends to spread early.

Is Inflammatory Breast Cancer Better or Worse Than Typical Breast Cancer?

Very much so. By the time that inflammatory breast cancer makes itself known with its overt symptoms, it is likely at a high stage already or soon to enter into this state, whereupon treatment effectiveness and survival rates decrease.

Comparison to Other Breast Cancer Types

IBC is generally considered more aggressive than other forms of breast cancer due to:

• Faster Growth: It progresses within weeks or months, compared to years for many other breast cancers.
• Higher Metastasis Tendency: At diagnosis, IBC is already at stage 3 or 4 in most cases, meaning it has spread beyond the breast.
• Lower Treatment Response: Due to its speedy development, IBC often does not respond as well to traditional treatments like surgery alone.

While some forms of breast cancer remain localized for a long time, IBC spreads quickly to lymph nodes and distant organs, such as the lungs, liver, and brain. This makes it one of the deadliest breast cancers, requiring incredibly taxing treatment from the outset.

Does Inflammatory Breast Cancer Require Unique Treatments?

In addition to its relentless pace, IBC’s resilience is one of its most defining features. While its brisk replication makes it highly responsive to chemotherapy, being found at such a late juncture necessitates more layered tactics.

Standard Treatment Plan

Because of its agile, invasive nature, IBC treatment requires a multimodal approach:

1. Chemotherapy
   • Given before surgery (neoadjuvant chemotherapy) to shrink the cancer.
   • Side effects: hair loss, nausea, fatigue, low blood cell counts.
2. Surgery (Mastectomy)
   • Complete removal of the affected breast, including lymph nodes.
   • Unlike other breast cancers, lumpectomy (removal of only the tumor) is not an option for IBC due to its diffuse nature.
   • May not be suitable for patients with extensive metastasis.
3. Radiation Therapy
   • Used after surgery to kill any remaining cancer cells.
   • Side effects: skin irritation, fatigue, swelling.
4. Targeted Therapy and Hormonal Therapy
   • If IBC is HER2-positive, drugs like Trastuzumab (Herceptin) or Pertuzumab (Perjeta) may be used.
   • If IBC is hormone receptor-positive, hormonal therapy (Tamoxifen or Aromatase Inhibitors) may help.
5. Immunotherapy
   • Drugs like Atezolizumab (Tecentriq) or Pembrolizumab (Keytruda) may help the immune system attack cancer cells, particularly for triple-negative IBC cases.

What is the Survival Rate for IBC?

Prognosis and Survival Statistics

Inflammatory Breast Cancer has a lower survival rate compared to other breast cancers due to its late-stage diagnosis and quick spread:

• Stage 0 IBC: Stage 0 Inflammatory Breast Cancer does not exist, as IBC is always invasive by the time it is diagnosed.
• Stage 1 IBC: IBC is rarely, if ever, diagnosed at Stage 1, as symptoms typically indicate an advanced disease.
• Stage 2 IBC: 60-70% 5-year survival rate. Despite this drastically lower survival rate for a stage 2, this type of breast cancer will usually only be diagnosed at the later tiers.
• Stage 3 IBC: 40-60% 5-year survival rate.
• Stage 4 IBC (metastatic): 11-20% 5-year survival rate.

Factors Affecting Survival Rates

• Early Detection: Since IBC is already advanced at diagnosis, early intervention is critical.
• Response to Treatment: Some patients respond well to chemotherapy, improving their prognosis.
• Molecular Subtype: HER2-positive IBC cases tend to respond better to targeted therapies.

Inflammatory Breast Cancer Remedy Research

Inflammatory Breast Cancer is one of the most challenging types of breast cancer, but ongoing research continues to show possibilities for progress. New treatments, such as immunotherapy and targeted therapies, are improving survival rates.

Recent Breakthroughs and Clinical Trials

Clinical trials are testing innovative therapies to slow the disease and improve quality of life for patients:

1. HER2-Targeted Therapies

For HER2-positive inflammatory breast cancer, the introduction of HER2 inhibitors like Trastuzumab (Herceptin), Pertuzumab (Perjeta), and Tucatinib (Tukysa) has revolutionized treatment. These drugs block HER2 receptors, slowing cancer growth and preventing further spread. Newer HER2-targeted drugs, such as Enhertu (Trastuzumab Deruxtecan) and Margetuximab, are being studied to further enhance survival rates in HER2-positive IBC patients.

2. Checkpoint Inhibitors (Immunotherapy) for Triple-Negative IBC

For triple-negative inflammatory breast cancer (TNBC-IBC), where no hormone or HER2 receptors are present, immune checkpoint inhibitors like Atezolizumab (Tecentriq) and Pembrolizumab (Keytruda) have shown great promise. These drugs help the immune system recognize and destroy cancer cells. The KEYNOTE-522 trial found that adding Pembrolizumab to chemotherapy significantly improved response rates and extended survival in TNBC-IBC patients.

3. mRNA-Based Cancer Vaccines

Inspired by COVID-19 mRNA technology, researchers are developing mRNA-based cancer vaccines to stimulate the immune system against Inflammatory Breast Cancer recurrence. These vaccines train the immune system to target residual cancer cells, potentially reducing relapse rates. Early trials at Johns Hopkins and Memorial Sloan Kettering have shown favorable immune responses, with larger clinical trials now underway.

4. Antibody-Drug Conjugates (ADCs)

One of the biggest breakthroughs in IBC treatment is the development of antibody-drug conjugates (ADCs) like Sacituzumab Govitecan (Trodelvy). This treatment delivers chemotherapy directly to cancer cells, minimizing damage to healthy cells. The ASCENT trial demonstrated that Trodelvy significantly extends survival in patients with metastatic triple-negative IBC who have undergone multiple treatments.

5. CAR-T Cell Therapy: A Future Possibility?

Chimeric Antigen Receptor (CAR)-T cell therapy, which has shown success in blood cancers, is now being tested in solid tumors like inflammatory breast cancer. This therapy genetically engineers a patient’s immune cells to specifically attack cancer cells. Recent Progress: While still in early-phase clinical trials, researchers at MD Anderson Cancer Center have reported strong results in advanced breast cancer cases, including IBC.

6. AI-Driven Personalized Treatment Approaches

Artificial intelligence (AI) is now being used to analyze inflammatory breast cancer tumor genetics and create personalized treatment plans. AI-based models can predict which drug combinations will work best for a specific patient’s cancer, reducing trial-and-error treatments. AI-driven clinical trials at Dana-Farber Cancer Institute have successfully matched patients to more effective treatment regimens.

While IBC remains a serious diagnosis, advances in treatment are making a real difference in patient outcomes. In our next article, we will explore HER2-Positive Breast Cancer, another complex but treatable subtype of breast cancer.