The role of vascular endothelial growth factor in kidney and prostate cancer

Vascular endothelial growth factor (VEGF) is a key regulator of physiological angiogenesis, but has also been implicated in pathological angiogenesis associated with renal cell carcinoma (RCC) and prostate cancer (PCa).

This review of literature underlines the recent advances in the understanding of how VEGF acts through these two malignancies, its potential value as a diagnostic and prognostic marker, as well as the development of new therapeutic strategies targeting the VEGF pathway.

In RCC, VHL gene inactivation mediates over-expression of VEGF. Multiple approaches to block VEGF signaling in kidney cancer have been tested. VEGFR-specific small molecule tyrosine kinase inhibitors (TKIs), multikinase inhibitors (MKI) and monoclonal antibodies (Mabs) against VEGF have been evaluated in patients with RCC in phase II-III trials. The development of these new treatment strategies led to the attempt to identify predictive markers of treatment benefit. However, no true marker has been yet identified. In PCa, VEGF expression is regulated by androgens, and recent studies suggest a correlation between angiogenesis and biological aggressiveness. Some authors have investigated the value of VEGF as a screening test for PCa, as a tool for PCa staging, and as a target for therapeutic strategies.

The understanding of the VEGF pathway and the development of angiogenesis-directed therapies have had a major impact on the treatment of metastatic RCC. In PCa, the usefulness of VEGF as a prognostic factor is highly suggested, but remains to be clarified. In addition, anti-angiogenic treatments targeting the VEGF pathway are currently under investigation.