The addition of bevacizumab to neoadjuvant chemotherapy in HER2-negative inflammatory breast cancer, more not necessarily better

Inflammatory breast cancer (IBC) is rare and aggressive form of invasive ductal carcinoma with a 5-year survival rate of only 40% as compared to 85% survival rate in other types of breast cancer patients (1,2). The poor prognosis of IBC is probably due to its high metastatic potential (3). The standard systemic management includes chemotherapy, in addition to anti-hormone and/or anti-human epidermal growth factor receptor-2 (anti-HER2) therapy, depending on the expression of the relevant receptors (3-8). Angiogenesis is known to be required for proliferation of tumor cell (9,10), the activity of which is determined by the extent of micro vessel density (MVD), which may serve as a surrogate of aggressiveness of the breast cancer (9). The most abundant angiogenic polypeptide expressed by primary breast cancers is vascular endothelial growth factor (VEGF) and is associated with increased angiogenesis (11,12). Besides angiogenesis, VEGF is also associated with endothelial and tumor cell growth and motility, as well as, blood vessel permeability (13).