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Outcomes of High-Dose Chemotherapy and Autologous Stem-Cell Transplantation in Stage IIIB Inflammatory Breast Cancer

From the Divisions of Bone Marrow Transplantation and Stem Cell Biology, Medical Oncology, and Biostatistics, Washington University School of Medicine, Midwest Hematology/Oncology Group, Inc, Hematology/Oncology Associates, Inc, Midwest Hematology/Oncology Consultants, Inc, Missouri Cancer Care, PC, Medical Oncology/Hematology, PC, Hematology/Oncology Consultants, Inc, and University Hematology/Oncology, St Louis, MO; Division of Hematology/Medical Oncology, Oregon Health Sciences University, Portland, OR; Division of Hematology, University of Texas Health Sciences Center, San Antonio, TX; and Hematology/Oncology at St John's Pavilion, Springfield, and Illinois Oncology Associates, Belleville, IL.

Address reprint requests to Douglas R. Adkins, MD, Division of Bone Marrow Transplantation, Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8007, St Louis, MO 63110-1093; email dadkins{at}imgate.wustl.edu

PURPOSE: To evaluate the disease-free survival (DFS) and overall survival (OS), prognostic factors, and treatment-related mortality of women with stage IIIB inflammatory breast cancer (IBC) treated with combined modality therapy (CMT) and high-dose chemotherapy (HDCT) with autologous stem-cell transplantation.

PATIENTS AND METHODS: Between 1989 and 1997, 47 consecutive patients with stage IIIB IBC were treated with CMT and HDCT and were the subject of this retrospective 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 prescribed to patients with estrogen receptor (ER)–positive cancer.

RESULTS: The mean duration of follow-up from diagnosis was 30 months (range, 6 to 91 months) and from HDCT was 22 months (range, 0.5 to 82 months). At 30 months, the Kaplan-Meier estimates of DFS and OS from diagnosis were 57.7% 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 multivariate 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 patients with ER-positive breast cancer. At last follow-up, 28 patients (59.6%) were alive and disease-free. Seventeen patients (36.2%) developed recurrent breast 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 HDCT compare favorably with other series of patients with stage IIIB IBC treated with CMT alone. These outcomes must be confirmed with longer follow-up and controlled studies.

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