Inflammatory Breast Cancer Course

  
Presenter: Massimo Cristofanilli, M.D.
Adjunct Professor
Department of Breast Medical Oncology
 

Introduction to Inflammatory Breast Cancer: Clinical Diagnosis   

Summary: Inflammatory breast cancer (IBC) is an extremely aggressive disease. One of the major difficulties in effectively diagnosing IBC is recognizing the signs and symptoms of this complex disease. Patients are frequently misdiagnosed, delaying their treatment. A comprehensive baseline assessment and timely initiation of appropriate therapy is essential. In his introductory lecture, Dr. Massimo Cristofanilli, Adjunct Professor of Breast Medical Oncology and Founder of The Morgan Welch Inflammatory Breast Cancer Research Program and Clinic at The University of Texas MD Anderson Cancer Center, presents a lecture titled, "Inflammatory Breast Cancer: Clinical Diagnosis" in which he updates health care practitioners about this disease. Dr. Cristofanilli overviews the epidemiology, etiology, biology, pathologic features, screening techniques, and presenting signs and symptoms of IBC, emphasizing the need for early definitive diagnosis for improved patient outcomes.
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Summary: Inflammatory breast cancer (IBC) is an aggressive form of breast cancer that develops in a short time and is frequently self-detected and misdiagnosed. The prognosis of patients with IBC has only marginally improved with standard therapies over the last 10 - 15 years. Micrometastatic disease at diagnosis and lymphangitic and lymphatic spread account for the high incidence of soft tissue recurrence. Understanding the biological features that underlie the malignant course of IBC and the molecular characteristics that distinguish IBC from non-inflammatory breast cancers are necessary for the development of new targeted therapies that will improve patient outcomes. In his lecture titled, "Biologic Features of Inflammatory Breast Cancer," Dr. Massimo Cristofanilli, Adjunct Professor of Breast Medical Oncology and Founder of the Morgan Welch Inflammatory Breast Cancer Center at The University of Texas MD Anderson Cancer Center, discusses the implications of hormone receptor status and the important histopathological characteristics of IBC, focusing on the significance of dermal lymphatic invasion and the formation of tumor emboli. Dr. Cristofanilli overviews current investigations into the molecular pathways that have been postulated to be important in IBC disease progression, with specific reference to p53, EGF-R, angiogenesis, hypoxia, lymphangiogenesis, chemokines, and the implications of possible cooperation between estrogen and growth factor receptors. Elucidating the molecular mechanisms that promote IBC genesis and progression may direct research toward promising new molecular targets that will improve the treatment of patients with IBC.
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Summary: Inflammatory breast cancer (IBC) is a locally advanced, inoperable disease at the time of presentation, and 30% of cases are metastatic on presentation. It is, therefore, essential for patients to undergo multidisciplinary management of this aggressive disease as early as possible. Physicians at The University of Texas MD Anderson Cancer Center have over 30 years of experience in treating IBC and have systematically compared the impact of treatment protocols and combination modalities, including the addition of induction chemotherapy to traditional treatment modalities. In his lecture, "Multidisciplinary Treatment of Inflammatory Breast Cancer," Dr. Massimo Cristofanilli, Adjunct Professor of Breast Medical Oncology and Founder of the Morgan Welch Inflammatory Breast Cancer Center at The University of Texas MD Anderson Cancer Center, reviews historical treatment regimens and discusses how understanding the biology of IBC drives the emerging multidisciplinary management of this disease to improve patient outcomes. Multidisciplinary care for IBC includes induction chemotherapy or systemic chemotherapy and surgery and, in many cases, chest wall radiation for local, regional, and distant control. As pathologic response to induction chemotherapy remains the most important prognostic factor, Dr. Cristofanilli discusses how model management of IBC should mirror knowledge of IBC biology and should be personalized to address Her2 and growth factor receptor status of the individual patient. Dr. Cristofanilli acknowledges the limitations of current therapy and offers commentary on promising new targeted investigational agents.
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Presenter: Savitri Krishnamurthy, M.D.
Professor, Department of Pathology

 

Summary: Inflammatory breast cancer (IBC) is a rare, aggressive type of breast cancer that compromises 1-5% of all newly diagnosed breast cancers. Physician recognition and early diagnosis of IBC are critical because the overall survival rate is lower for it than for other breast cancers (50%). Dr. Savitri Krishnamurthy, Professor of Pathology at The University of Texas MD Anderson Cancer Center, said that "Recognition of inflammatory breast carcinoma by physicians and awareness of the public is definitely essential for accurate diagnosis and optimal clinical management of the patients." In her lecture, entitled Inflammatory Breast Cancer Pathology, Dr. Krishnamurthy identifies the diagnostic criteria for establishing a diagnosis of IBC and describes how to recognize the pathological features of IBC in the skin and breast, the differential diagnosis of IBC, and how to be become familiar with the distribution of standard and potentially useful biomarkers in IBC tissue sections.
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Presenter: Anthony Lucci Jr., M.D.
Professor, Department of Surgical Oncology

 

Summary: Surgery is an important component in treatment planning for patients with Inflammatory Breast Cancer (IBC). Dr. Anthony Lucci, Professor of Surgical Oncology at The University of Texas MD Anderson Cancer Center said that “Surgery can help achieve local control in the majority of patients,” but he recommends surgery not as the first step of treatment but as part of a trimodal protocol. “Systemic therapy up front is key to a better outcome for patients,” said Dr. Lucci. In his lecture, The Role of Surgery in Inflammatory Breast Cancer Patients, Dr. Lucci presents recent data on patient outcomes following mastectomy vs multiple modality therapy, and explores several case scenarios that show why neoadjuvant chemotherapy followed by mastectomy and then radiation therapy has proven to produce the best results in most IBC patients. Additionally, Dr. Lucci discusses optimal surgical treatments for the breast and regional lymph nodes in patients with IBC and identifies reconstructive and rehabilitative issues after surgery.
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Presenter: Thomas A. Buchholz, M.D.
Director, Inflammatory Breast Cancer Program
Professor and Chair, Department of Radiation Oncology
Professor, Department of Pathology

Summary: Multimodality treatment is best for patients with inflammatory breast cancer. Patients who receive systemic therapy followed by mastectomy can derive great benefit from postmastectomy radiation to reduce the likelihood of locoregional recurrence. Dr. Thomas Buchholz, Director of The Inflammatory Breast Cancer Program and Professor and Chair of the Department of Radiation Oncology at The University of MD Anderson Cancer Center, says data show that “[post-mastectomy radiation] is going to result in an overall survival advantage for patients with inflammatory breast cancer.” In his lecture, “Locoregional Treatment and Survival in Inflammatory Breast Cancer,” Dr. Buchholz reviews the historical evidence that underpins multimodality treatment protocols for locoregional control of inflammatory breast cancer. He identifies the factors associated with treatment outcomes and the survival benefits that occur in patients treated with radiation therapy. He then discusses the importance of specialized radiation techniques and doses in the multimodality approach used to treat patients with inflammatory breast cancer. Dr. Buchholz also presents recent data that analyze which molecular subtypes are associated with locoregional recurrence and how each subtype affects survival in 316 MD Anderson patients with inflammatory breast cancer. Dr. Buchholz discusses the critical need to develop novel therapeutic approaches for patients with inflammatory breast cancer, particularly those with triple-negative disease.
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