Anti-angiogenic therapies in cancer: achievements and open questions

Area of Science:

• Oncology
• Molecular Biology
• Pharmacology

Background:

• The 2004 approval of bevacizumab (Avastin), a vascular endothelial growth factor (VEGF) inhibitor, marked a milestone in cancer treatment by validating anti-angiogenic therapy.
• This success spurred the development of new anti-angiogenic targets and drugs, building on Judah Folkman's hypothesis that inhibiting tumor angiogenesis controls tumor growth.

Purpose of the Study:

• To review outstanding questions in anti-angiogenic therapy, including surrogate markers, therapy synergy, biological consequences, and resistance mechanisms.
• To highlight future challenges in clinical, translational, and experimental research to improve current treatments and design novel anti-angiogenic drugs.

Main Methods:

• Literature review of anti-angiogenic therapy research.
• Synthesis of current knowledge on tumor angiogenesis and its inhibition.
• Identification of key unanswered questions and future research directions.

Main Results:

• Bevacizumab's approval confirmed anti-angiogenesis as a viable cancer treatment strategy.
• Several critical questions remain, including the need for reliable markers, understanding drug synergy, and characterizing long-term effects and escape mechanisms.
• Significant challenges persist in optimizing anti-angiogenic therapies and developing next-generation drugs.

Conclusions:

• Anti-angiogenic therapy, initiated by bevacizumab, represents a significant advance in cancer treatment.
• Addressing fundamental questions regarding markers, synergy, biological impact, and resistance is crucial for future progress.
• Continued research is essential to refine existing therapies and discover innovative anti-angiogenic treatments for improved patient outcomes.