Angiogenesis Inhibitors for Colorectal Cancer. A Review of the Clinical Data

SIMPLE SUMMARY: Targeting angiogenesis, the formation of new blood vessels, is an integral part of many cancer treatments, including colorectal cancer. The overall clinical benefit is well documented but modest. It has been an ongoing task for the last decade to isolate patient and tumor characteristics instrumental in identifying the subgroups to truly benefit; so far with limited success. The introduction of immunotherapy has opened a new era for anti-angiogenic treatment, as these two therapeutic strategies seem to work in synergy. This review will highlight the clinical achievements of anti-angiogenic treatment of colorectal cancer since 2004 and elaborate on the perspectives of combining it with immunotherapy. ABSTRACT: Since the late 1990s, therapy for metastatic colorectal cancer (mCRC) has changed considerably, and the combination of doublet or triplet chemotherapy and a targeted agent are now routinely used. The targeting of angiogenesis, the development of new blood vessels, represents a key element in the overall treatment strategy. Since the approval in 2004 of the first anti-angiogenetic drug, multiple agents have been approved and others are currently under investigation. We present an overview of the recent literature on approved systemic treatment of mCRC, with a focus on anti-angiogenic drugs, and current treatment approaches, and elaborate on the future role of angiogenesis in colorectal cancer as seen from a clinical perspective. The treatment of mCRC, in general, has changed from “one strategy fits all” to a more personalized approach. This is, however, not entirely the case for anti-angiogenetic treatments, partly due to a lack of validated biomarkers. The anti-angiogenetic standard treatment at the present primarily includes monoclonal antibodies. The therapeutic field of angiogenesis, however, has received increased interest after the introduction of newer combinations. These approaches will likely change the current treatment strategy, once again, to the overall benefit of patients.