Antiangiogenic treatment in patients with non-small cell lung cancer

Abstract

The use of agents addressing angiogenesis may potentially improve outcomes of patients with lung cancer. The results of numerous studies evaluating an antiangiogenic therapy in non-small cell lung cancer are much more promising in comparison with trials in small cell lung cancer. Bevacizumab, a recombinant humanised monoclonal antivascular endothelial growth factor antibody, improved significantly progression- -free and overall survival when combined with platinum-based first-line chemotherapy in selected patients with advanced non-small cell lung cancer. Some toxic effects, particulaly tumor-related bleeding, were associated with the addition of bevacizumab to chemotherapy predominantly in patients with squamous-cell and centrally located tumours. Several small-molecule vascular endothelial growth factor receptor tyrosine kinase inhibitors (eg., sorafenib and sunitinib) are under investigation and early results of the studies justify further research in lung cancer. In general, the value of clinical and molecular predictive markers has to be elucidated given the significant toxicities and costs of antiangiogenic agents. Trials adressing the issue of optimal treatment duration are also mandatory, since current paradigm of continuing antiangigenic therapy until progression or unacceptable toxicity is based on theoretical grounds only.