Stopping the Growth and Spread Of Cancers
In order for cancers to grow and spread they need to form “new” blood vessels (angiogenesis). In recent years a new class of drugs was developed called angiogenesis inhibitors that have the specific function of stopping the formation of new blood vessels in tumors.
The first angiogenesis inhibitor that was FDA approved was bevacizumab (Avastin), which is a monoclonal antibody that binds to VEGF (vascular endothelial growth factor A) blocking the formation of new blood vessels.
The major side effects are high blood pressure, in patients with CAD can cause a heart attack, and gastrointestinal bleeding and perforation can occur.
Bevacizumab has been used most commonly with chemotherapy in advanced colon, lung, ovarian and renal cell cancer or as maintenance therapy after chemotherapy. Bevacizumab has improved response rates, disease-free survival and overall survival.
Ramucirumab (Cyramza) is a fully human monoclonal antibody that binds to VEGFR 1 E blocking the receptor therefore suppressing the formation of new blood vessels. It is FDA approved for gastric, gastro esophageal and colon cancer. As bevacizumab, it is intravenous. The major side effects are high blood pressure, diarrhea, hyponatremia and headache. Less common side effects are bleeding and perforation and infusion related reaction.
Ziv-Aflibercept (VEGR-TRAP) is a peptide antibody fusion targeting VEGF ligand – VEGF-A, VEGF-B and PLGF. It prevents angiogenesis (blood vessel formation) in tumors. It is given in combination with chemotherapy for advanced stage colorectal cancer.
The most common side effects are low blood count, diarrhea, HTN, nose bleed, proteinuria. Less common but severe side effects include internal bleeding. The monoclonal antibodies with antiangiogenic properties are administered intravenously.