Inflammatory breast cancer – or IBC – is an aggressive subtype of breast cancer that often presents as a breast rash, and not a lump. It progresses rapidly and is often misdiagnosed, or diagnosis is delayed, resulting in more later-stage cases when prognosis is poorer.
Susan G. Komen is awarding a $350,000 grant to Dr. Filipa Lynce and Dr. Wendy Woodward to test a new clinical tool that seeks to aide in the accurate and timely diagnosis of IBC through a verified scoring system. Drs. Lynce and Woodward recently talked with Susan G. Komen about their research and the potential to catch IBC earlier with this new tool and use effective treatments in patients.
Komen: What drew you to inflammatory breast cancer research?
Dr. Lynce: One of the things that drew me to the field of inflammatory breast cancer is that although we have made significant progress in breast cancer over the last years, we are still lagging behind in IBC. We have many patients to whom we cannot offer a cure, lack good treatment options or experience significant toxicities from all the treatments received. So patients with IBC are clearly an unmet need in breast oncology.
Dr. Woodward: As part of the effort to put together a comprehensive research team, MD Anderson was looking for someone with expertise in cancer stem cells. I had just finished my residency and fellowship with Dr. Jeff Rosen at Baylor, who is a mammary stem cell expert, and that was the work that I was continuing on as a faculty member. I was asked to bring that expertise into the group, and it sort of naturally turned all of my research toward inflammatory breast cancer.
Komen: The grant you’re receiving from Susan G. Komen will help advance collaboration between Dana-Farber and MD Anderson. How important is that collaboration between these two leading cancer institutions for advancing our understanding of IBC?
Dr. Lynce: As with any rare disease, we can achieve better patient outcomes by working together. All of us in IBC need to work together to design the best clinical trials and make sure each patient with IBC is offered the opportunity to participate. IBC is a disease that faces so many challenges, starting with the diagnosis, that it is of paramount importance that we establish collaborations with researchers in the lab, clinicians and patient advocates as well.
Dr. Woodward: The collaboration is incredibly important. With this IBC collaboration, we now have a “formal” pipeline to generate infrastructure, harmonize our databases, make it possible that anyone at either institution at any time could produce an idea, be directed to all of the right folks, know exactly how many patients an idea might impact and begin to work through that process. So, with this collaboration, we’re trying to make it efficient; we’re trying to make it high impact for both groups. This is an opportunity to both explore a question and then validate the result in an independent data set – it means you can turn that result around in a clinically impactful way quickly.
Komen: Your research will test a set of criteria that has recently been established for diagnosing IBC. What will your findings mean for patients, who are often misdiagnosed or diagnosed late, when their cancer is later stage?
Dr. Woodward: The main benefit is to help reduce the number of patients who are misdiagnosed, and to make it easier for patients and for physicians by having a tool so that patients can be diagnosed correctly, wherever they are. I think that the vast majority of academic and community physicians make the diagnosis correctly in the obvious inflammatory breast cancer patient. But the reality is IBC is a spectrum of clinical symptoms that vary dramatically across patients. And so being able to make a diagnosis in a subtle or atypical case, is critical.
Dr. Lynce: Our research efforts are currently focused on two main areas – one is the challenge associated with the diagnosis of inflammatory breast cancer. This is too dependent on the provider’s experience and subjective interpretation of the clinical criteria that lead to its diagnosis. The second effort of our IBC program is focused on the identification of targets that may be unique to IBC, or that are responsible for the aggressiveness of this disease.
Komen: It sounds like educating providers across the country about IBC is critical so that patients can get the same care, no matter where they seek care. Once you’ve validated the criteria for diagnosing IBC, how can providers be educated so that they can make proper diagnoses?
Dr. Woodward: There are some great examples that we can model. For example, large cancer institutions have used data to generate calculators that tell you the risk of a non-Sentinel lymph node having having cancer. There are web-based applications where anyone can open a link, enter the data into the calculator and generate a score that helps you to make clinical decisions. I think it’s certainly possible that we will be able to publish and share with the world that we have validated the scoring system for diagnosing IBC and then create a simple-to-use score sheet whereby anyone could enter the information and calculate the score, which hopefully would help them make decisions about IBC diagnosis and treatment.
Komen: Historically, there have not been clinical trials just for patients with IBC. It sounds like after your validation study is complete, there might be an opportunity in the future to create trials specifically for patients with IBC.
Dr. Lynce: It is really important that we focus our efforts in developing trials for patients with IBC. Because this is a rare disease, clinical trials will often include one or two patients with IBC, and this if patients with IBC are not excluded to participate. If the number of patients with IBC is low, you might miss data pointing to efficacy of a certain drug. Or it could be the other way around where the trial might be positive, overall, but if you look carefully at patients with IBC, you will see that for some reason that particular drug is not a good option for patients with IBC. It is critical that while we create trials with dedicated cohorts for IBC or dedicated trials for IBC patients, we also must make progress on how to better identify patients with IBC.
Komen: What does the grant you’re receiving to continue your IBC research mean to you?
Dr. Woodward: I want to highlight the uniqueness of what Komen is providing here, in terms of the infrastructure and support and funding to create not just the score for diagnosing IBC, but also the mechanism of collaboration to continue to develop and to facilitate this work. And the fundraising, I think is just an incredible model for how to facilitate progress in a rare subtype or breast cancer, and it’s really exciting. It’s amazing what Komen has done here.
Komen: What do you want for patients who are diagnosed with IBC?
Dr. Lynce: My hope for any patient with IBC is that they are offered a timely and correct diagnosis. Each patient with IBC should be offered the best treatment options that are available, and each patient with IBC should be counted in ongoing research efforts. Not only those who are treated at IBC dedicated programs, but any patient with IBC diagnosed in the US or around the world, so that we can make progress faster.
*Dr. Lynce is a breast medical oncologist and Director of the Inflammatory Breast Center at Dana-Farber Cancer Institute. Dr. Woodward is the Chief of the Clinical Breast Radiotherapy Service in the Department of Radiation Oncology and the Deputy Director of the Morgan Welch Inflammatory Breast Cancer Clinic and Research Program at The University of Texas MD Anderson.