Chemotherapy for Inflammatory Breast Cancer

Inflammatory breast cancer (IBC) is a rare, aggressive type of breast cancer that occurs when cancerous cells block lymph vessels in the skin of the breast. Unlike most breast cancers, IBC typically does not form a distinct lump that can be felt or seen on a mammogram. Instead, it may cause swelling, redness and warmth in the breast, similar to an infection. Other common symptoms include itching, thickened skin and dimpling that resembles an orange peel (peau d’orange).

Because the warning signs of IBC tend to appear quickly, the cancer is often diagnosed at a late stage, after it has invaded nearby lymph nodes or the chest wall. The diagnostic process typically involves a combination of physical examination, imaging tests and a biopsy to confirm the presence of cancer cells.

"Although we understood the severity of what I was dealing with, Dr. Susan Hoover promised and assured me that I was going to be on the other side of cancer in two years."

Tiffany, Breast Cancer Survivor

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In the United States, IBC accounts for approximately 5% of all breast cancer cases, predominantly affecting women younger than 40. Treatment usually begins with systemic therapy, such as chemotherapy, followed by surgery, radiation therapy and possibly hormone therapy. Given its aggressive nature, early recognition and specialized treatment are essential to achieve the best possible outcome and quality of life.

When is chemotherapy used for inflammatory breast cancer?

Chemotherapy is usually the first step of IBC treatment, mainly because the cancer tends to grow and spread rapidly. Systemic therapy is generally started as soon as possible to target cancer cells that may have begun to migrate throughout the body. In many cases, chemotherapy is given before surgery to shrink the cancer and increase the likelihood of successful removal. Chemotherapy can also be used after surgery to destroy any remaining cancer cells and lower the risk of recurrence.

What does chemotherapy for inflammatory breast cancer involve?

Chemotherapy uses strong medications that enter the bloodstream and circulate throughout the body to reach and destroy widespread cancer cells. For IBC, treatment usually involves a combination of drugs. For instance, many patients receive both anthracycline- and taxane-based chemotherapy. Additionally, if the cancer is HER2-positive, targeted therapy drugs, such as trastuzumab, may be included for heightened treatment effectiveness. Usually, the drugs are given in cycles over several months. Each cycle includes a period of active treatment followed by a period of rest to allow the body time to recover.

What happens during chemotherapy for inflammatory breast cancer?

Chemotherapy for IBC is usually administered intravenously at a cancer treatment center, hospital or outpatient infusion center. Depending on the medications prescribed, each session can last up to several hours. While receiving chemotherapy, the patient will be monitored closely with periodic blood tests, imaging scans and physical exams, allowing the physician to continually evaluate the response and adjust the treatment plan if needed.

What are the possible side effects of chemotherapy for inflammatory breast cancer?

Chemotherapy drugs are powerful, and as they work to destroy cancer cells, they sometimes damage healthy cells as well. Depending on the cells affected, this can lead to a variety of side effects, such as fatigue, nausea, vomiting, diarrhea, hair loss, reduced appetite and increased risk of infection. Some patients may also develop mouth sores or neuropathy. While the severity of these side effects can vary, most are temporary and subside once treatment is complete. In the meantime, any chemotherapy-related discomfort can usually be managed with supportive care and medications prescribed by the oncology team.

What are the risks and possible complications of chemotherapy for inflammatory breast cancer?

Many side effects of chemotherapy are common and manageable. However, the treatment also carries a risk of more serious complications, such as:

• Infertility – Some chemotherapy drugs can damage the ovaries, which can lead to irregular menstrual cycles and premature menopause symptoms, such as hot flashes and vaginal dryness. If ovulation ceases, pregnancy will be impossible.
• Bone thinning – Women who experience early menopause due to chemotherapy may have a higher risk of developing bone-thinning conditions, such as osteopenia and osteoporosis.
• Heart damage – Although the risk is slight, chemotherapy can cause irregular heartbeats (cardiotoxicity), valve issues and heart muscle weakening (cardiomyopathy).

While rare, chemotherapy can also increase the risk of developing another cancer, such as leukemia, later in life. To help prevent and manage the risks and possible complications, the patient will be monitored carefully both before and during treatment.

What to expect during recovery from chemotherapy for inflammatory breast cancer

Recovery after chemotherapy takes time, as the body gradually regains strength and blood cell levels return to normal. Many side effects begin to improve within a few weeks of completing treatment, although the fatigue may last longer. Supportive care, proper nutrition, rest and regular follow-up visits with the oncology team can help ease the recovery process and prepare the patient for the next phase of treatment, which may include surgery or radiation therapy.

How effective is chemotherapy for inflammatory breast cancer?

Chemotherapy is an integral part of IBC treatment. In many cases, it reduces the cancer and leads to a complete pathological response, which means no cancer cells are found at the time of surgery.

While inflammatory breast cancer remains more challenging to treat than many other types of breast cancer, systemic therapy continues to advance. Studies show that chemotherapy can significantly improve the patient’s outcome and quality of life, especially when combined with surgery and radiation therapy.

Benefit from world-class care at Moffitt Cancer Center

Moffitt takes a comprehensive, multimodal approach to treating inflammatory breast cancer. Within our Don & Erika Wallace Comprehensive Breast Program, a multispecialty team collaborates with each patient to create a highly individualized chemotherapy plan, tailored to the specifics of the patient’s diagnosis, overall health and personal preferences. Our breast cancer oncologists also work closely with fertility specialists to support our patients who are pregnant or planning for future childbearing. When appropriate, chemotherapy can be carefully timed during pregnancy, or fertility- and breastfeeding-preservation options can be explored before treatment begins.

As a National Cancer Institute-designated Comprehensive Cancer Center, Moffitt is recognized for its groundbreaking research and innovation. Through our extensive portfolio of clinical trials, our patients can gain early access to promising new chemotherapy drugs and drug combinations not yet widely available.

If you would like more information, you can request an appointment with a specialist in the Don & Erika Wallace Comprehensive Breast Program by calling 1-888-663-3488 or submitting a new patient registration form online. Chemotherapy for IBC is offered at all Moffitt locations, and no referral is required.