Paclitaxel in the multimodality treatment for inflammatory breast carcinoma

BACKGROUND. Inflammatory breast carcinoma (IBC) is a rare but aggressive fo rm of breast carcinoma. Anthracycline-based regimens represent the standard of treatment for IBC. Reports of significant clinical activity of paclitax el in metastatic breast carcinoma led the authors to investigate the role o f this drug in the management of IBC. METHODS. Forty-four patients with IBC were enrolled between February 1994 a nd January 1998. The treatment plan consisted of induction chemotherapy (IC ), mastectomy, adjuvant chemotherapy, and radiotherapy. Forty-two patients received IC with four cycles of fluorouracil, doxorubicin, and cyclophospha mide. If the clinical response was less than partial, patients were "crosse d over" to paclitaxel before mastectomy. All patients received adjuvant pac litaxel. Patients unresectable after paclitaxel were offered high-dose chem otherapy with autologous peripheral blood progenitor cell support. RESULTS. Thirty-four patients (81%) achieved an objective clinical remissio n; 3 patients (7%) achieved a clinical complete remission, 31 (74%) a parti al remission. Six patients (14%) achieved pathologic complete remission. Si xteen patients were treated with paclitaxel, 7 of them (44%) were able to u ndergo mastectomy. Median time to progression (TTP) was 22 months. Median o verall survival (OS) was 46 months. Concordance between clinical and pathol ogic response was documented in only 8 patients (24%). No differences in TT P and OS compared with a historical group of 178 IBC patients treated with anthracycline-based regimens. CONCLUSIONS. Paclitaxel improves tumor resectability in anthracycline-refra ctory IBC. The impact of paclitaxel on the prognosis of IBC needs to be bet ter evaluated in future trials using more dose-intensive schedules of admin istration. New imaging modalities may contribute to improve assessment of r esponse to IC. (C) 2001 American Cancer Society.