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Published on: November 23, 2014
Antiangiogenic therapy in breast cancer
Simon Peter Gampenrieder1,2,3, Theresa Westphal1,2,3, Richard Greil1,2,3
1IIIrd Medical Department with Hematology and Medical Oncology, Oncologic Center, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, 5020 Salzburg, Austria.
Abstract:
Based on a strong rationale for anti-VEGF (vascular endothelial growth factor) treatment in breast cancer and promising preclinical data, great hopes have been placed on the anti-VEGF antibody bevacizumab. Clinical trials, however, reported conflicting results. In metastatic human epidermal growth factor receptor 2(HER2)-negative breast cancer, the addition of bevacizumab to standard chemotherapy improved consistently progression-free survival (PFS), however, without effect on overall survival (OS). In early breast cancer bevacizumab increased the pathologic complete response rate (pCR) after neoadjuvant therapy, but adjuvant trials did not demonstrate an effect on long-term survival. Unfortunately, despite extensive research, there is still no biomarker for bevacizumab efficacy available, making patient selection difficult. This review summarizes all phase III trials investigating efficacy and toxicity of bevacizumab in early, locally advanced and metastatic breast cancer. It recapitulates the main toxicities, gives an overview on biomarker studies and discusses the role and future aspects of antiangiogenic therapy in breast cancer.
Insights
Bevacizumab, an anti-VEGF antibody, shows mixed results in breast cancer trials. While improving progression-free survival in metastatic cases, it lacks overall survival benefits and a reliable biomarker for patient selection remains elusive.
Area of Science:
- Oncology
- Medical Research
Background:
- Anti-VEGF therapy, specifically bevacizumab, was investigated for breast cancer based on preclinical data.
- Clinical trials yielded conflicting outcomes regarding bevacizumab's efficacy in various breast cancer stages.
Purpose of the Study:
- To review phase III trials on bevacizumab's efficacy and toxicity in early, locally advanced, and metastatic breast cancer.
- To summarize bevacizumab's main toxicities and review biomarker studies.
- To discuss the future role of antiangiogenic therapy in breast cancer treatment.
Main Methods:
- Systematic review of phase III clinical trials involving bevacizumab in breast cancer.
- Analysis of progression-free survival (PFS), overall survival (OS), and pathologic complete response (pCR) rates.
- Evaluation of reported toxicities and biomarker research.
Main Results:
- In metastatic HER2-negative breast cancer, bevacizumab improved PFS but not OS when added to chemotherapy.
- In early breast cancer, bevacizumab increased pCR in neoadjuvant settings but showed no long-term survival benefit in adjuvant trials.
- No reliable biomarker for bevacizumab efficacy has been identified, complicating patient selection.
Conclusions:
- Bevacizumab demonstrates a complex efficacy profile across different breast cancer contexts.
- The lack of predictive biomarkers hinders optimal patient selection for anti-VEGF therapy.
- Further research is needed to define the role and optimize the use of antiangiogenic agents in breast cancer management.
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