Anti-Angiogenic Strategies in Breast Cancer: An Update

Angiogenesis plays a role in primary tumor growth and metastatic potential of breast cancer, and within the past decade, the development of angiogenesis inhibitors has been a significant focus of clinical research efforts. Multiple studies to date have confirmed a role for bevacizumab, a monoclonal antibody against vascular endothelial growth factor (VEGF), in combination with chemotherapy in the treatment of metastatic breast cancer. Efforts to determine the efficacy of second-generation VEGF receptor antagonists in breast cancer patients are ongoing. In addition, trials are underway to investigate potential synergy between anti-angiogenic agents and other classes of breast cancer therapeutics and to examine the efficacy of angiogenesis inhibition in nonmetastatic disease. Preliminary work evaluating predictors of response to therapy, including serologic biomarkers, class-effect toxicity, or dynamic radiologic change, and pharmacogenetics, has been promising; however, future study is critical to best identify the patient population most likely to benefit from anti-angiogenic therapy.