Antiangiogenesis in the treatment of NSCLC. Part 2 of a 3-part series: Targeting VEGF - Current and future research directions

There is a great need for new therapeutic approaches in non-small cell lung cancer (NSCLO), which is the leading cause of cancer deaths in the United States. Antiangiogenesis has come to the forefront to fill this need. Therapeutics that target various proangiogenic factors, such as vascular endothelial growth factor (VEGF), are thought to prevent tumor growth and future metastases by inhibiting tumor blood vessel formation. These agents are being tested alone, in combination with each other, and with chemotherapy. Initial results suggest that the biologics may work synergistically and may improve the ability of traditional chemotherapeutics to attack tumor cells. Three types of anti-angiogenic drugs are currently being tested for NSCLC: monoclonal antibodies, small molecule inhibitors that target single pathways, and multitargeted inhibitors. The most heavily investigated agent is bevacizumab, a monoclonal antibody against VEGF. Other the rapeutics include the epidermal growth factor receptor inhibitor erlotinib and the multitargeted agents ZD6474 and sorafenib. Future areas of research in NSCLC will include using the most effective therapies in less advanced disease settings, overcoming the resistance to certain biologics seen in some patient populations, and pinpointing the most appropriate settings and combinations in which to use the biologic agents.