Clinical and Translational Oncology

, Volume 18, Issue 8, pp 760–768 | Cite as

Closing faucets: the role of anti-angiogenic therapies in malignant pleural diseases

  • D. Marquez-MedinaEmail author
  • S. Popat
Review Article


Malignant pleural effusion (MPE) represents 15–35 % of pleural effusions and markedly worsens the prognosis and quality of life of patients with cancer. Malignant mesothelioma (MM) and lung adenocarcinoma are the most frequent primary and secondary causes, respectively, of MPE. Effective treatments for cancer-related MPE are warranted in order to improve symptoms, reduce the number of invasive pleural procedures, and prolong patient life. Since angiogenesis plays a key role in MPE development, the potential role of bevacizumab and other anti-angiogenic therapies have been explored in this review. No relevant phase III trials have specifically analysed the benefit from adding bevacizumab to platinum-based chemotherapy in lung cancer-related MPE. However, small retrospective series reported 71.4–93.3 % MPE control rate, a reduction in invasive procedures, and a safe profile with this combination. Being approved for the first-line treatment of non-squamous advanced NSCLC, the addition of bevacizumab should be considered for patients presenting with MPE. In addition, further studies in this are recommended. In MM, the addition of bevacizumab to platinum-based chemotherapy did not meet primary endpoints in two phase II trials. However, the beneficial results on OS reported in comparison with historical cohorts and the statistically significant benefit on PFS and OS observed in the phase III MAPS trial foretell an eventual role for the combination of platinum/pemetrexed/bevacizumab as front-line systemic therapy for pleural MM. To date, no other anti-angiogenic drug has showed significant benefit in the treatment of patients with either MPE or MM. However, new promising drugs such as ramucirumab or recombinant human endostar warrant further investigation.


Anti-angiogenesis Bevacizumab Malignant pleural effusion Malignant mesothelioma Non-small cell lung cancer 



The Spanish Society of Medical Oncology (SEOM) supported the collaboration of D.M. as Honorary Observer in the Royal Marsden Hospital. S.P. acknowledges NHS funding to the Royal Marsden Hospital/Institute of Cancer Research NIHR Biomedical Research Centre.

Compliance with ethical standards

Conflict of interest

S.P. is consultant to AstraZeneca, Boehringer Ingelheim, BMS, Lilly, MSD, Novartis, Pfizer, and Roche. D.M. has participated as speaker and advisor for Roche, Boehringer Ingelheim, Astra-Zeneca, Lilly, Novartis, and Pierre-Fabre events.

Informed consent and participants

The present review did not involve human participants or animals. So, the asking of informed consent was not necessary.


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Copyright information

© Federación de Sociedades Españolas de Oncología (FESEO) 2015

Authors and Affiliations

  1. 1.Medical Oncology DepartmentArnau de Vilanova University HospitalLleidaSpain
  2. 2.Lung Cancer UnitRoyal Marsden HospitalLondonUK

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