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World J Clin Oncol. Feb 24, 2019; 10(2): 52-61
Published online Feb 24, 2019. doi: 10.5306/wjco.v10.i2.52
Existing anti-angiogenic therapeutic strategies for patients with metastatic colorectal cancer progressing following first-line bevacizumab-based therapy
Ozkan Kanat, Hulya Ertas
Ozkan Kanat, Hulya Ertas, Department of Medical Oncology, Faculty of Medicine, Uludag University, Bursa 16059, Turkey
Author contributions: Kanat O assigned the issue, performed the majority of the writing, and prepared the figures and tables; Ertas H performed extensive literature research on the subject.
Conflict-of-interest statement: There is no conflict of interest associated with any of the senior authors or other coauthors contributed their efforts in this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Ozkan Kanat, MD, PhD, Professor, Department of Medical Oncology, Faculty of Medicine, Uludag University, Gorukle, Bursa 16059, Turkey. ozkanat@uludag.edu.tr
Telephone: +90-22-42951321 Fax: +90-22-42951341
Received: September 25, 2018
Peer-review started: September 25, 2018
First decision: November 1, 2018
Revised: November 8, 2018
Accepted: January 5, 2019
Article in press: January 6, 2019
Published online: February 24, 2019
Abstract

Continuous inhibition of angiogenesis beyond progression is an emerging treatment concept in the management of metastatic colorectal cancer patients with prior bevacizumab exposure. Treatment options include the continuation or reintroduction of bevacizumab during the second-line chemotherapy or switching to a different antiangiogenic monoclonal antibody such as aflibercept or ramucirumab. In the selection of treatment, patient-based factors such as performance status, age, tumor burden, and tolerance and sensitivity to the first-line bevacizumab-based therapy, as well as treatment-related factors such as toxicity, efficacy, and cost, should be taken into consideration.

Keywords: Angiogenesis inhibition, Second-line chemotherapy, Colorectal cancer, Bevacizumab, Aflibercept, Ramucirumab

Core tıp: Anti-angiogenic treatment is an essential part of the current armamentarium against metastatic colorectal cancer (mCRC). For now, bevacizumab is the only drug licensed for the treatment of chemotherapy-naïve patients with mCRC. However, patients undergoing first-line bevacizumab-based therapy eventually develop disease progression and become candidates for second-line chemotherapy. In this manuscript, we discuss the available anti-angiogenic therapeutic strategies that have been proven to be useful in the treatment of patients with mCRC in whom first-line bevacizumab-based therapy was ineffective.