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  • The major difference between early breast cancers and locally advanced breast cancers (LABCs) include the extent of disease involvement and associated poor survivals. Both inflammatory breast cancer (IBC) and noninflammatory LABC are rare yet contribute to high morbidity and mortality.

  • Both IBC and noninflammatory LABC require multidisciplinary care including medical oncology, surgical oncology, and radiation oncology. Effective induction strategy starting with the neoadjuvant systemic therapy (NAST) followed by aggressive local therapy including surgery and radiation is the best approach to reverse the poor outcome of these diseases.

  • The unique biological cause of LABC that distinguishes it from other types of breast cancer may not be fully elucidated in the near future. In contrast, in IBC, recent enhancement of methods of biological interrogation has led to novel insights and development of novel therapeutic; however, the practice change is yet to follow, emphasizing the importance of ongoing efforts to change the grim clinical outcome.

  • Compared with other noninflammatory breast cancer, stage III noninflammatory breast cancer harbor worse event-free and overall survivals. Early recognition, distinction from other LABCs, and early/accurate intervention are critical in the treatment of this dismal disease. The local therapy approach for IBC is different from other LABCs, and adherence to aggressive multimodality therapy has been shown to improve survival.

  • Various new strategies are being tested in clinical trial settings to improve the response to the NAST, yet no new systemic therapeutics have been approved by the FDA. We anticipate several agents (eg, anti-programmed cell death–1 agents) to be approved as part of standard care in this setting.

  • Additional strategies (eg, alternative/additive adjuvant therapies along with integrated biomarkers such as liquid biopsy to monitor early relapse) should be considered as a next step to improve the outcome of these breast cancers.


Locally advanced breast cancer (LABC) metastasizes and recurs frequently and is associated with poor overall survival (OS). Inflammatory breast cancer (IBC) is a rare form of LABC associated with distinctly worse survival.1 Timely diagnosis, aggressive neoadjuvant systemic therapy (NAST), surgery, and radiation therapy, combined with novel diagnostic and therapeutic approaches based on new biological insights and delivered by a well-trained and well-coordinated team, is critical to improving the survival of patients with these cancers. Here we present current treatment recommendations for LABC and IBC from a panel of experts at MDACC and discuss future directions in the development of novel therapies for these diseases.


LABC is breast cancer that extends beyond the breast to the chest wall and/or multiple levels of regional lymph nodes but has not spread to distant sites and therefore is curable (ie, stage III). Not all stage III breast cancer falls into the LABC category, but most do. LABC can result from aggressive, rapidly growing breast cancers such as IBC or from more slowly growing breast cancers when appropriate medical care is not delivered in a timely manner. According ...

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