Outcomes of high-dose chemotherapy and autologous stem-cell transplantation in stage IIIB inflammatory breast cancer

Purpose: To evaluate the disease-free survival (DFS) and overall survival ( OS), prognostic factors, and treatment-related mortality of women with stag e IIIB inflammatory breast cancer (IBC) treated with combined modality ther apy (CMT) and high-dose chemotherapy (HDCT) with autologous stem-cell trans plantation. Patients and Methods: Between 1989 and 1997, 47 consecutive patients with s tage IIIB IBC were treated with CMT and HDCT and were the subject of this r etrospective analysis. Chemotherapy was administered to all patients before and/or after definitive surgery. Neoadjuvant and adjuvant chemotherapy was administered to 33 and 34 patients, respectively, and 20 patients received both. All patients received HDCT with autologous stem-cell transplantation , and 41 patients received locoregional radiation therapy Tamoxifen was pre scribed to patients with estrogen receptor (ER)positive cancer. Results: The mean duration of follow-vp from diagnosis was 30 months (range , 6 to 91 months) and from HDCT wets 22 months (range, 0.5 to 82 months). A t 30 months, the Kaplan-Meier estimates of DFS and OS from diagnosis were 5 7.7% and 59.1%, respectively. At 4 years, the Kaplan-Meier estimates of DFS and OS from diagnosis were 51.3% and 51.7%, respectively. In a multivariat e analysis, the only factors associated with better survival were favorable response to neoadjuvant chemotherapy (P = .04) and receipt of tamoxifen (P = .06); however, the benefit of tamoxifen was only demonstrated in patient s with ER-positive breast cancer. At last follow-up, 28 patients (59.6%) we re alive and disease-free. Seventeen patients (36.2%) developed recurrent b reast cancer. Seventeen patients died: 15 from disease recurrence and two ( 4.2%) from treatment-related mortality due to HDCT: Conclusion: In this analysis, the early results of treatment with CMT and H DCT compare favorably with other series of patients with stage IIIB IBC tre ated with CMT alone. These outcomes must be confirmed with longer follow-up and controlled studies. (C) 1999 by American Society of Clinical Oncology.