Targeting Inflammatory Breast Cancer: current and new treatments
Literature Review
Fatoumata Diallo
ENG 21003: Writing for the sciences
Professor Brittany Zayas
April 9, 2025
Introduction
Breast cancer is a form of cancer that occurs in women and can very rarely occur in men It is seen when either tumor suppressor or oncogenes mutate. Inflammatory Breast Cancer is a rare and very aggressive form of breast Cancer. It only accounts for 1% to 5% of all Breast Cancer. It is called “inflammatory” because some of the symptoms cause the breast to look inflamed due to cancer cells blocking lymph vessels in the skin. IBC typically does not have the same symptoms as other forms of breast cancer and doesn’t always show up on mammograms making it harder to diagnose. Inflammatory breast cancer is the least talked about form of breast cancer and has the least amount of awareness. Breast cancer awareness is crucial because it allows women to get screened and early screening saves lives, awareness also raises funds for women to afford treatments. There is a huge gap between the survival rates for IBC compared to other forms of breast cancer. Inflammatory Breast Cancer is harder to treat than most cancers, Treatments can Include; Surgery, Chemotherapy, Targeted Therapies, and Radiation.
Descriptions:
Inflammatory Breast Cancer is an aggressive and rapidly spreading form of breast cancer; it accounts for 2-4% of all breast cancers and is responsible for 7% of all breast cancer-related deaths (Chippa, Barazi, 2023). There are two subcategories of Inflammatory breast cancer: Primary IBC and Secondary IBC. In Primary IBC cancer develops in a healthy breast while in secondary the cancer recurs or shows up where a previous breast cancer occurred (Robertson et al., 2010). Most IBCs are hormone receptor-negative meaning they have shorter disease-free survival; IBC also has excessive amounts of HER2 proteins which lead to rapid growth of the tumor. The p53 tumor suppressor gene(TSG) plays a huge role in IBC, Mutation, or the increase of the p53 TSG happens in “20-50%” of all breast cancers including IBC, and is linked to hereditary breast cancer syndrome it often associated with larger tumors and a higher chance of death, this becomes worse when p53 tag is combined with negative estrogen receptors this only increases the risk of death (Chippa, Barazi, 2023). There was also an overexpression of the RhoC GTPase oncogene. The RhoC GTPase oncogene contributes to the aggression of IBC.
Symptoms & Diagnosis
Symptoms of IBC occur rapidly in this particular cancer. “One of the most frequently described changes associated with IBC is erythema, where the skin overlying the breast shows a pink or mottled pink hue”, erythema(redness), and orange peel appearance (Robertson et al., 2010). IBC spreads fast so often redness can cover 1/3 of the breast, also within a few days the skin can change from pink to dark red/purple (Fattahi et al., 2022).
Doctors diagnose IBC in 2 ways; clinically and pathologically. IBC can often be misdiagnosed with other conditions such as melanoma and other metastatic cancers. “IBC needs to be Both clinically and pathologically diagnosed. A core needle is used to verify the invasive carcinoma, while a skin biopsy shows a dermal lymphatic invasion” (Chippa, Barazi, 2023). Since inflammatory Breast Cancer is a very fast-spreading carcinoma it is harder to diagnose, pathological and clinical methods are best for an accurate diagnosis DLI cannot only confirm IBC because it can be found in other breast cancers. Only 10% of IBC cases are detected through mammograms, many people are often misdiagnosed, and they are often told to take antibiotics (Chippa, Barazi, 2023). Mammograms are not effective, but ultrasound helps with finding the tumor and lymph nodes, MRIs are great for tracking the tumor, and PET/CT scans help with tracking tumor growth (Robertson et al., 2010). Imaging is beneficial when tracking tumors and tumor growth.
Treatments
Typical Treatment for IBC consists of a combination of chemotherapy, surgery, and radiation. Chemotherapy is an important type of systemic treatment because it shrinks the tumor before surgery. Studies have shown that Neoadjuvant chemotherapy has resulted in higher PCR (pathologic complete response) rates in er negative IBC (Chainitikun et al., 2021). Higher PCR rates can mean an increase in survival. Targeted therapies are another form of IBC treatment but there is limited information on them. If the cancer is HER-2 positive, targeted therapy trastuzumab is given along with the chemo, sometimes along with another targeted drug, Pertuzumab.
The current treatment for IBC is Radiation which is often extremely aggressive due to high dosages and is often very toxic for IBC patients. A study was conducted to Test Intensity-modulated proton therapy (IMPT), a form of radiotherapy meant to target and shrink the tumor while minimizing exposure to other organs. IMPT reduces the toxicity of the radiation due to accurate rapid dose fall-off (Fattahi et al., 2022). In this study (2016-2020) they test the possibility of IMPT. They treated 19 IBC patients with adjuvant IMPT. Treatment planning started 4-7 weeks (about 1 and a half months) post-op. They used CT scans for CTV coverage and dosage. The Radiation targeted the chest wall, lymph nodes, and skin (Fattahi et al., 2022.).
Risks Factors
IBC is a rare and aggressive form of BC that is responsible for “8-10%” of all BC deaths (Chainitikun et al., 2021). There are many risk factors of IBC such as race, Obesity, and age. Black women and younger women have higher IBC rates and worse survival rates compared to white women. “African American women were found to have an incidence of IBC at least 50% higher than white women, to be diagnosed at younger ages, and to have decreased survival times” (Robertson et al., 2010). Obesity is a huge factor for IBC especially for women who go through menopause (Robertson et al., 2010). IBC has similar risk factors as other breast cancers such as if a woman has had previous radiotherapy or if they have a history including breast cancer.
Conclusion:
Overall, Inflammatory Breast Cancer should be taken seriously and encouraged to be in discussions of medical emergencies. Those who care to listen should be urged by more doctors to listen and take their health seriously. Overall, Inflammatory Breast Cancer is a rare and rapidly spreading form of breast cancer. Typically, IBC is treated with surgery, chemotherapy, and radiation, but new treatments are being researched such as targeted therapies and other forms of radiation affects mostly black, younger, and obese women. IBC is seen when either tumor suppressor or oncogenes mutate, because of its aggressive nature IBC is harder to diagnose and treat.
Works Cited
Chippa, V., & Barazi, H. (2023, April 16). Inflammatory breast cancer. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK564324/#article-111445.s2
Chainitikun, S., Saleem, S., Lim, B., Valero, V., & Ueno, N. T. (2021). Update on systemic treatment for newly diagnosed inflammatory breast cancer. Journal of Advanced Research, 29, 1–12. https://doi.org/10.1016/j.jare.2020.08.014
Fattahi, S., Mullikin, T. C., Aziz, K. A., Afzal, A., Smith, N. L., Francis, L. N., Harmsen, W. S., Routman, D. M., Remmes, N. B., Ahmed, S. K., Shumway, D. A., Park, S. S., Mutter, R. W., & Corbin, K. S. (2022). Proton therapy for the treatment of inflammatory breast cancer. Radiotherapy and Oncology, 171, 77–83. https://doi.org/10.1016/j.radonc.2022.04.008
Robertson, F. M., Bondy, M., Yang, W., Yamauchi, H., Wiggins, S., Kamrudin, S., Krishnamurthy, S., Le-Petross, H., Bidaut, L., Player, A. N., Barsky, S. H., Woodward, W. A., Buchholz, T., Lucci, A., Ueno, N., & Cristofanilli, M. (2010). Inflammatory breast cancer: The disease, the biology, the treatment. CA: A Cancer Journal for Clinicians, 60(6), 351–375. https://doi.org/10.3322/caac.20082
