Evaluating the effectiveness of adding targeted therapy to chemotherapy before surgery for inflammatory breast cancer.

This study evaluated the effectiveness of adding targeted therapy to chemotherapy before surgery for the treatment of patients with inflammatory breast cancer (IBC). The data showed that adding targeted therapy is more effective than chemotherapy alone for these patients.

IBC is a rare and aggressive form of breast cancer (BC), accounting for 2% of all BCs. It is termed 'inflammatory' as the breast appears red, swollen, and 'inflamed'. Metastasis (the spread of cancer to distant organs) is typically observed in 30% of all new IBC cases. Standard treatment for IBC is usually chemo-radiotherapy, surgery, and targeted therapies.

BC is classified into different subtypes depending on the presence or absence of certain receptors (proteins found on the surface of the cancer cells). HER2 positive is a subtype of BC in which cancerous cells contain high levels of the HER2 protein. Patients with this subtype of BC commonly receive targeted therapy such as trastuzumab (Herceptin). However, all the targeted therapies have been shown to be effective in patients with non-IBC.

Many studies have shown that adding targeted therapy to neoadjuvant chemotherapy (NAC; treatment before surgery) improves the pathological complete response (pCR; the absence of any cancer cells left after surgery) rate for BC. However, there are no studies investigating the effectiveness of adding targeted therapy to NAC for the treatment of patients with IBC.

This study analyzed 23 studies involving a total of 1269 patients with IBC. Patients were divided into 3 groups, based on the treatment they received before surgery. Group 1 included 329 patients who received chemotherapy with targeted therapy. Group 2 included 571 patients who received chemotherapy alone. Group 3 included 369 patients who received high-dose chemotherapy.

The average pCR rate of group 1 was 31.6%. For group 2 this rate was 13%, and for group 3 was 23%. Patients with HER2-positive IBC who were treated with chemotherapy and targeted anti-HER2 therapy achieved a high pCR rate of 54.3%.

This study concluded that NAC plus targeted therapy is more effective than NAC alone for patients with IBC. The authors support the current standard practice and the use of current anti-HER2 targeted therapy for patients with HER2-positive IBC.

This study did not include any randomized studies that included only IBC patients. This study did not include newer targeted therapy like pertuzumab or immunotherapy that has recently demonstrated effectiveness in BC. Differences in the intensity of the dose and schedule of chemotherapy might influence some conclusions.