Systemic and targeted therapy

Historically, single-modality therapy failed to control inflammatory breast cancer (IBC), a very aggressive and rare type of advanced breast cancer with poor prognosis. With the introduction of multimodality treatment (primary and adjuvant systemic therapy, surgery, and radiation therapy), the prognosis of inflammatory breast cancer (IBC) has significantly improved. Current standard treatment of IBC consists of primary systemic therapy, including trastuzumab for HER-2/neu overexpressing IBC, followed by surgery with mastectomy and complete axillary lymph node dissection, and subsequently radiation therapy. Novel agents for systemic therapy have been investigated. Lapatinib, neratinib, pertuzumab, TDM-1, are the most promising targeted therapy in HER2-positive IBC. Molecular targets for vasculolymphatic processes“angiogenesis, lymphangiogenesis, and vasculogenesis”have shown greater potential in IBC than in non-IBC. Recent developments in molecular targeting toward WISP3 and RhoC GTPase may also be effective against IBC. Although loss of E-cadherin is a hallmark of invasive disease and epithelial-to-mesenchymal transition, paradoxically, E-cadherin is overexpressed in IBC. IBC’s low incidence has limited the research on this aggressive disease, which points to the need for worldwide collaboration aimed at optimizing a more effective multidisciplinary approach to fight this disease.