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Inhibition of Tumor Angiogenesis in the Treatment of Lung Cancer

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Tumor Angiogenesis

Abstract

Several anti-angiogenic drugs have been investigated in patients with thoracic malignancies. In patients with advanced, non-squamous, non-small-cell lung cancer (NSCLC), the anti-Vascular Endothelial Growth Factor (VEGF) monoclonal antibody bevacizumab is approved in combination with first-line platinum-based chemotherapy. The use of bevacizumab has been restricted to patients with non-squamous tumors, due to safety reasons related to the relevant risk of life-threatening bleeding in squamous tumors. Consistently with the schedule tested in pivotal trials, bevacizumab is administered concomitant with chemotherapy, followed by single-agent maintenance therapy until disease progression or unacceptable toxicity. More recently, bevacizumab has also shown efficacy when added to erlotinib as first-line treatment of cases with activating mutations of Epidermal Growth Factor receptor (EGFR). Both the anti-VEGF receptor (VEGFR) monoclonal antibody ramucirumab (in squamous as well as non-squamous tumors) and the small molecule tyrosine kinase inhibitor nintedanib (in patients with adenocarcinoma) have shown efficacy in addition to docetaxel as second-line treatment of advanced NSCLC, after failure of platinum-based chemotherapy. Unfortunately, to date, similarly to other tumors, in patients with advanced NSCLC no useful predictive factors of efficacy have been validated for anti-angiogenic drugs. In completely resected early stage NSCLC, bevacizumab in combination with chemotherapy has been also tested as adjuvant treatment, but no impact on outcome was demonstrated. In small cell lung cancer, no anti-angiogenic drug has produced successful results. Treatment options for patients with malignant pleural mesothelioma have been recently enriched by the addition of bevacizumab to cisplatin plus pemetrexed as first-line therapy, as reported in one phase III study.

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Authors and Affiliations

  1. Department of Oncology, University of Turin, Turin, Italy

    Massimo Di Maio, Silvia Novello, Enrica Capelletto & Giorgio Vittorio Scagliotti

  2. Medical Oncology, Mauriziano Hospital, Turin, Italy

    Massimo Di Maio

  3. Medical Oncology, S. Luigi Gonzaga Hospital, Regione Gonzole 10, 10043, Orbassano (TO), Italy

    Silvia Novello, Enrica Capelletto & Giorgio Vittorio Scagliotti

Authors
  1. Massimo Di Maio
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  2. Silvia Novello
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  3. Enrica Capelletto
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  4. Giorgio Vittorio Scagliotti
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Corresponding author

Correspondence to Giorgio Vittorio Scagliotti .

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Editors and Affiliations

  1. Tumor Biology Center, Freiburg, Baden-Württemberg, Germany

    Dieter Marmé

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Di Maio, M., Novello, S., Capelletto, E., Scagliotti, G.V. (2017). Inhibition of Tumor Angiogenesis in the Treatment of Lung Cancer. In: Marmé, D. (eds) Tumor Angiogenesis. Springer, Cham. https://doi.org/10.1007/978-3-319-31215-6_22-1

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  • DOI: https://doi.org/10.1007/978-3-319-31215-6_22-1

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