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The Intriguing Role of Bevacizumab in Advanced Breast Cancer – The Search Continues

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Published Online: May 15th 2012 European Oncology & Haematology, 2012;8(3):179-183 DOI:
Authors: José Pablo Leone, Ricardo H Álvarez
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Angiogenesis plays an important role in the biology of tumour progression and therapies that target the vascular endothelial growth factor (VEGF) pathways – ligands, receptors and co-receptors – have become an important treatment for many types of cancer. Bevacizumab, a monoclonal antibody against VEGF, was explored in several randomised Phase III studies conducted in patients with metastatic breast cancer. However, despite bringing improvements in progression-free survival, the use of bevacizumab has not been associated with improvements in overall survival. Further improvements in predictive biomarkers and the development of biology-driven Phase II trials will be critical to help us understand which patients would benefit the most from anti-angiogenic therapy.


Bevacizumab, breast cancer, anti-angiogenesis, vascular endothelial growth factor


Breast cancer continues to be a very prevalent disease worldwide. It is estimated that more than 39,000 women died of breast cancer in the US in 2011.1 Advances in the treatment of early-stage disease, including screening programmes for breast cancer detection and adjuvant systemic therapies, have improved outcomes for patients. Despite these improvements, however, many women ultimately develop metastatic breast cancer (MBC), which is essentially an incurable disease. The prognosis of patients with MBC has changed little over the past decade; the majority of patients succumb to their disease within two years of diagnosis.2–4 Novel treatments for patients with MBC are needed to improve the control of disease and prevent symptoms while minimising toxicity.

Role of Angiogenesis in Cancer Biology
In 1970, Folkman postulated that tumour progression might be dependent on angiogenesis – the formation of new blood vessels.5 The hypothesis was that a tumour cannot grow without blood supply and that, therefore, the inhibition of angiogenesis would be an important treatment for all cancers.

Angiogenesis is an important natural process of new blood vessel formation that occurs in the body, both in health and in disease.6 Thegeneration and growth of solid tumours depend on an intact vascular supply, which is stimulated by several pro-angiogenic factors. Changes in the finely balanced equilibrium between angiogenicstimulators and inhibitors that regulate angiogenesis are linked to a broad range of angiogenesis-dependent diseases, including both cancer and non-neoplastic diseases.7 Angiogenesis is now recognised as one of the key steps in the pathogenesis of cancer, regulating several events required for tumour development, invasion and metastasis.8,9

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Article Information:

The authors have no conflicts of interest to declare.


Ricardo H Álvarez, Department of Breast Medical Oncology, Unit 1354, The University of Texas MD Anderson Cancer Center, PO Box 301439, Houston, Texas 77030-3721, US. E:




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