INSPIRE study - INflammatory breast cancer Surgery: PreservIng versus Radical therapy - a rEgistry-based study

Abstract

Inflammatory breast cancer (IBC) is the most aggressive subtype of breast cancer and is traditionally treated with multimodal therapy including mastectomy and axillary lymph node dissection, regardless of response to neoadjuvant therapy (NAT). In contrast to other breast cancer subtypes, patients with IBC have largely been excluded from prospective trials evaluating less invasive axillary approaches such as sentinel lymph node biopsy (SLNB), targeted lymph node biopsy (TLNB), or targeted axillary dissection (TAD). However, emerging evidence suggests that the therapeutic value of routine axillary dissection in IBC may be limited. Large database analyses show no survival benefit of radical axillary surgery in clinically node-negative IBC (1), while real-world data indicate that a considerable proportion of patients achieve complete nodal response (ypN0) after NAT, particularly in triple-negative and HER2-positive disease (2, 3). These findings raise concerns about potential axillary overtreatment in IBC and highlight the need to re-evaluate current surgical standards (4). Given the lack of prospective trials, registry-based studies provide an important opportunity to analyze real-world outcomes, identify patients who may benefit from surgical de-escalation, and generate evidence to guide future prospective studies.