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Targeted Therapy of Colorectal Cancer: Clinical Experience with Bevacizumab

Department of Medical Oncology and Transplantation, Duke University Medical Center, Durham, North Carolina, USA

Correspondence: Herbert I. Hurwitz, M.D., Department of Medical Oncology and Transplantation, Box 3052, Duke University Medical Center, Durham, North Carolina 27710, USA. Telephone: 919-681-5257; Fax: 919-684-9712; e-mail: hurwi004{at}mc.duke.edu

Advanced colorectal cancer remains an urgent health concern, despite improvements in systemic chemotherapy. Targeted therapeutics promise effective tumor therapy with minimal side effects. Angiogenesis (the formation of new blood vessels) is essential for tumor growth and metastasis and may be an ideal target in the search for new antineoplastic agents. Vascular endothelial growth factor is one of the best characterized of the proangiogenic growth factors that regulate angiogenesis and is a logical target in colorectal cancer therapy. Bevacizumab (Avastin^TM; Genentech Inc.; South San Fransisco, CA), a humanized murine monoclonal antibody directed at vascular endothelial growth factor, is being evaluated in the treatment of various types of cancer. It has shown promising efficacy in phase II clinical trials in patients with metastatic colorectal cancer. Addition of bevacizumab at a dose of 5 mg/kg to chemotherapy (5-fluorouracil plus leucovorin) resulted in a higher objective response rate (40% versus 17%), longer time to disease progression (9.0 versus 5.2 months), and longer median survival time (21.5 versus 13.8 months). Hypertension and thrombosis were the principal safety concerns, but were manageable. Further phase II/III studies of bevacizumab, administered with 5-fluorouracil plus leucovorin, with or without irinotecan and/or oxaliplatin, in colorectal cancer, are under way.

Key Words. Colorectal cancer • Clinical trial • Bevacizumab • Vascular endothelial growth factor • Monoclonal antibodies

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