New Hope for Inflammatory Breast Cancer: Rare but Fast Growing

Unlike other breast cancers, IBC does not present itself as a lump, but as inflammation. The symptoms a patient typically notices or feels include:

In general, IBC has a much poorer prognosis than other types of breast cancer because it spreads so quickly in the lymphatic channels, says Debu Tripathy, M.D., author of Breast Cancer: Beyond Convention and director of the Komen Center for Breast Cancer Research, University of Texas Southwestern Medical Center.

Dr. Sandra Swain, who is heading up a clinical trial on IBC at the National Institutes of Health, says IBC is characterized by high micro vessel density (MVD) and "MVD is associated with a poorer prognosis, probably because of increased angiogenesis." (Angiogenesis is the formation of new blood vessels. In cancer, new blood cells allow tumor cells to escape into the circulation and lodge in the body's organs.)

In addition, IBC, because of the way it presents itself — it isn't found by mammography or ultrasound — is often in an advanced stage by the time it is diagnosed. Generally, the earlier cancer is detected, the higher the five-year survival rate.

A diagnosis of IBC is very frightening, but it is "by no means a death sentence," says Dr. Tripathy, especially if the cancer has not metastasized.

Carole O'Toole was diagnosed with IBC in 1994. Despite the fact that the cancer had not metastasized, she was given 18 months to live. Her treatment regimen was brutal: five months of almost continuous chemotherapy, followed by a modified radical mastectomy and a bone-marrow transplant.

After undergoing treatment, O'Toole — a scientific researcher by profession — embarked on a mission to discover everything she could about IBC and complementary medical therapies to support her recovery. What she learned and what she did for herself — from guided imagery to spiritual work to vitamin therapy — is explained in her book, Healing Outside the Margins.

"Complementary therapy offered me the emotional and spiritual support I needed, and physically nurtured my body through its medical ordeal," writes O'Toole, who eight years after her grim prognosis is coaching other cancer patients on how to structure complementary treatment plans.

IBC patients with better-than-average survival rates like Carole O'Toole's are becoming more common, says Dr. Tripathy. That's because patients are more aware of IBC and physicians are making the right diagnosis the first time around, which is critical given IBC's rapid growth pattern. (IBC's symptoms mimic those of mastitis, a breast infection, so it has not been unusual for a woman with IBC to be prescribed antibiotics before being correctly diagnosed).

Clinical trials have shown that the most successful treatment for IBC is chemotherapy to shrink the tumor to an operable size, followed by a modified mastectomy to reduce the total number of cancer cells and radiation to kill remaining cancer cells. Combinations of these therapies have resulted in about 30 percent of patients surviving greater than five years without a recurrence.

In recent years, the use of very aggressive therapies, namely bone-marrow transplant and high-dose chemotherapy, has fallen out of favor. The results of these hard-hitting treatments, says Dr. Tripathy "are not necessarily better than what we see with standard protocols."

Clinical trials are under way to evaluate the effect on IBC remission rates of combining Herceptin, a relatively new drug that targets a specific protein on aggressive cancer cells, with standard chemotherapy drugs. Herceptin, Dr. Tripathy believes, may prolong the lives of advanced IBC patients who have the worst survival odds.

Another potential weapon in the fight against IBC could be heat therapy (hyperthermia). Researchers at Duke University are experimenting with the use of heat therapy to draw chemotherapy drugs encapsulated in tiny fat bubbles (liposomes) to tumors. The heat also triggers the liposomes to release the drugs, which settle inside the tumor. Since the drug is delivered only to the tumor, doctors can use higher does of chemotherapy — 30 times more than is standard — to kill cancer cells without poisoning other body tissues.

Little is know about IBC other than the fact that it spreads much faster than other breast cancers. Hence, controlling IBC's growth is a key area of research. At NIH in Bethesda, MD, Dr. Sandra Swain is conducting a clinical trial with the experimental anti-VEGF antibody (Avastin) on advanced breast cancer. Avastin targets a protein that promotes angiogenesis — the process of new blood formation that enables IBC cancer cells to progress so quickly throughout the body. "We are studying anti-VEGF in IBC in hopes of decreasing angiogenesis," Dr. Swain reports.

Another avenue of research is directed toward distinguishing the molecular fingerprint of IBC "so that we can understand why IBC is biologically different from other cancers," says Dr. Tripathy. Figuring out the differences in gene expression patterns between normal and IBC cancer cells may reveal what sets IBC apart from other cancers.

But unlike other beast cancers, IBC is not inherited, so discovery of IBC genes will not necessarily help predict who is more likely to get the disease. The finding of specific genetic markers in the tumors of a woman newly diagnosed with IBC, however, could be a valuable tool for designing treatment plans.

If doctors can better classify IBC, they can choose more targeted treatments to the classifications, explains Dr. Tripathy. "This would be much better than what we do now," he comments, which is "throw the entire book of treatments" at a patient.