For a patient with inflammatory breast cancer after standard initial systemic therapy with only a partial response, do you recommend more systemic therapy, pre-operative radiation, or proceed to modified radical mastectomy?

If the disease is operable with a partial response, then we proceed with surgery. Otherwise, we try a different chemo regimen and sometimes preoperative RT to make it operable.

The systemic therapy question was addressed and partly answered with the CreateX trial. In that 900 patient trial there was an improvement in DFS and OS with adjuvant capecitabine. The current EA1131 explores this question further, directly comparing cape to platinum. The randomization is stratified...