Abstract
Breast cancer is the most common malignancy among women in both developed and developing countries. The burden is increasing in low-income and middle-income countries (LMCs) and threatens the public health of such societies. Introduction of expensive monoclonal antibodies to cancer treatment regimens poses a real challenge in the health systems of LMCs. Despite controversy of cost-effectiveness of bevacizumab in breast cancer, some studies indicate gain of patients from this drug. The present study aimed to propose a priority setting model for administration of anti-angiogenic agents in breast cancer via assessment of tumor angiogenesis by the microvessel density (MVD) method and associations with clinicopathological characteristics (including simultaneous mutations of TP53 and HER-2 genes). Age, axillary lymph nodes status, tumor size, stage and grade, estrogen and progesterone receptors status, HER-2/neu status (by immunohistochemistry and FISH test), TP53 mutation, Ki-67 (for proliferation assay) and CD34 (for angiogenesis assay) were assessed in 111 breast cancer patients. The molecular subtype of each tumor was also determined and correlations of simultaneous mutations of HER-2 and p53 genes with angiogenesis and other clinicopathological characteristics were evaluated. There were significant associations between simultaneous mutations of HER-2 and p53 genes and all other parameters except tumor size. The degree of angiogenesis in the ERBB2 subtype was greater than the others. Younger patients showed a higher angiogenesis rate rather those older than 50 years. Our results demonstrated that patients with simultaneous mutations of HER-2 and p53 genes, those with ERBB2 molecular subtype and also younger women (often triple negative) seem more eligible for obtaining anti-angiogenic agents. These results suggest a model for priority setting of patients with breast cancer for treatment with anti-angiogenic drugs in LMCs.
Highlights
Breast cancer is the most common malignancy among women in both developed and developing countries
Our results demonstrated that patients with simultaneous mutations of HER-2 and p53 genes, those with ERBB2 molecular subtype and younger women seem more eligible for obtaining anti-angiogenic agents
The statistics, indicate a bitter truth that the mortality rate of breast cancer is increasing in low-income and middle-income countries (LMCs) because constraints on financial resources in these countries undermine screening managements, and the disease is detected in late stages, resulting in increased mortality risk (Pedraza et al, 2012)
Summary
Breast cancer is the most common malignancy among women in both developed and developing countries. The global burden of breast cancer is increasing in low-income and middle-income countries (LMCs) and it is considered as a threatening factor for their health systems (El Saghir et al, 2011; Story HL et al, 2012). It’s a common misconception that the incidence of breast cancer is high in developed countries. In Iran, according to the Breast Health Global Initiative Guideline (BHGI-2008) (Yip et al, 2008; El Saghir et al, 2011), which is a resource-sensitive guideline, HER-2/neu assessment and trastuzumab treatment are recommended for breast cancer. The direct medical costs for treatment of breast cancer is very high and the burden of disease is increasing in our country (Davari et al, 2013). If the government policy of UMICs on breast cancer treatment is made to allocate financial resources and support anti-angiogenic drugs such as bevacizumab (Avastin®, made by Genentech), how can it be effective as a scientific criteria for priority-setting?
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