Future use of bevacizumab and other anti-angiogenic agents in breast cancer

Bevacizumab, the first commercially available angiogenesis inhibitor for the treatment of breast cancer, offers significant clinical benefits in the management of this disease. When combined with paclitaxel as first-line treatment of metastatic breast cancer, it significantly increases both median progression-free survival and 1-year survival when compared with treatment with paclitaxel alone. Furthermore, the addition of bevacizumab to capecitabine in patients with more refractory advanced breast cancer was also found to be clinically active, significantly increasing response rate but not extending progression-free survival. Both the mechanism of action of bevacizumab and its clinical activity in advanced disease suggest that it should be active in adjuvant and neoadjuvant therapy. Inhibition of vascular endothelial growth factor should inhibit the growth of existing micrometastases following surgery (adjuvant therapy), and could enhance patient eligibility for breast conservation by decreasing tumour size (neoadjuvant therapy). A clinical trial programme is underway to evaluate the role of bevacizumab in combination with other anticancer agents in the first-line metastatic, adjuvant and neoadjuvant treatment of breast cancer.