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Gastrointestinal Cancer

Target Practice: Lessons from Phase III Trials with Bevacizumab and Vatalanib in the Treatment of Advanced Colorectal Cancer

Department of Medical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands

Key Words. Colorectal cancer • Angiogenesis inhibitors • Bevacizumab • Vatalanib

Correspondence: Emile E. Voest, M.D., Ph.D., Department of Medical Oncology F 02 126, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands. Telephone: 31-30-2506265; Fax: 31-30-2523741; email: e.e.voest{at}umcutrecht.nl

Vascular endothelial growth factor (VEGF) is one of the most important factors involved in tumor angiogenesis and has become an important target for anticancer treatment. In 2004, this approach was validated in a randomized, controlled phase III clinical trial. It was shown that the addition of bevacizumab, a humanized monoclonal antibody against VEGF-A, to conventional chemotherapy prolonged survival over chemotherapy alone in patients with metastatic colorectal cancer. In this review, we discuss the results of the clinical trials that have led to the incorporation of antiangiogenic agents into the treatment of patients with advanced colorectal cancer. We limit ourselves to the two agents that have been tested extensively in phase III trials: bevacizumab and vatalanib, a small molecule tyrosine kinase inhibitor against VEGF receptors. In addition, we discuss the adverse effects of bevacizumab and vatalanib and the clinical management of the side effects.

Disclosure of potential conflicts of interest is found at the end of this article.

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