This protocol applies to patients with inflammatory breast cancer in whom the initial preoperative (neoadjuvant) systemic treatment has not produced sufficient response — specifically, where reduction of the in-breast tumor and regression of the characteristic skin involvement have not been achieved to a degree that would allow operative management.
The prior treatment line was a preoperative anthracycline-based regimen, administered with or without taxanes. For HER2-positive disease, trastuzumab was included, and a pertuzumab-containing regimen may have been given preoperatively.
The goals that were not achieved: sufficient reduction of the in-breast tumor and regression of breast skin erythema, edema, and peau d'orange to enable surgical management.
After inadequate response to initial preoperative therapy, the approach involves additional cytotoxic chemotherapy and/or preoperative radiation to work toward achieving response and operability.
The primary aim is tumor response that renders the breast tumor operable. Evaluating response requires physical examination combined with imaging studies that were abnormal at initial staging.