The Use of Anti-angiogenic The Use of Anti-angiogenic Factors in the Treatment of Factors in the Treatment of

Oncologic DiseaseOncologic Disease

Kyle Treesh, PA-SKyle Treesh, PA-S

Bob Hadley, Ph.D., PA-C, Bob Hadley, Ph.D., PA-C, AdvisorAdvisor

University of KentuckyUniversity of Kentucky

Learning ObjectivesLearning Objectives

• Why do we need new cancer treatments?Why do we need new cancer treatments?

• What is angiogenesis?What is angiogenesis?

• What are the anti-angiogenesis agents?What are the anti-angiogenesis agents?

• What agents are FDA-approved?What agents are FDA-approved?

• What combinations of treatment are best?What combinations of treatment are best?

• What does the future hold for these What does the future hold for these therapies?therapies?

U.S. Cancer StatisticsU.S. Cancer Statistics

• Cancer is a major public health problem!Cancer is a major public health problem!• One in four deaths is due to cancer One in four deaths is due to cancer

(570,280 deaths in 2005)(570,280 deaths in 2005)• 1,372,910 new cancer cases in 20051,372,910 new cancer cases in 2005• Lung and bronchus, and colon and Lung and bronchus, and colon and

rectum equal 25% of total cancer deathsrectum equal 25% of total cancer deaths• Breast and Prostate cancers are Breast and Prostate cancers are

prevalent in their respective sexesprevalent in their respective sexes

What is angiogenesis?What is angiogenesis?

• Think way back to pathophysiology…Think way back to pathophysiology…

• Angiogenesis is the formation of blood vessels in a tissue Angiogenesis is the formation of blood vessels in a tissue initiated by VEGF and bfGFinitiated by VEGF and bfGF

• Angiogenesis aids in the healing of wounds, proliferates the Angiogenesis aids in the healing of wounds, proliferates the endometrium, and is a vital part of pregnancy endometrium, and is a vital part of pregnancy

• Tumors can also cause angiogenesis to occur in order to Tumors can also cause angiogenesis to occur in order to bring oxygen and nutrients to the tumor for growthbring oxygen and nutrients to the tumor for growth

• These new blood vessels are the vehicle for metastasisThese new blood vessels are the vehicle for metastasis

Anti-angiogenesis factorsAnti-angiogenesis factors

• Protein anti-angiogenic agentsProtein anti-angiogenic agents

• Monoclonal antibody anti-angiogenic Monoclonal antibody anti-angiogenic agentsagents

• Metronomic chemotherapyMetronomic chemotherapy

Bevacizumab/AvastinBevacizumab/Avastin

• 11stst FDA-approved Angiogenesis FDA-approved Angiogenesis InhibitorInhibitor

• Approved for use with chemotherapy Approved for use with chemotherapy in the treatment of colorectal cancerin the treatment of colorectal cancer

• Prolonged lives 5 months compared to Prolonged lives 5 months compared to standard treatmentstandard treatment

• No additional side effects!No additional side effects!• Not expected to be a cure, but Not expected to be a cure, but

provides hope for a longer lifeprovides hope for a longer life

Combination Therapies with Combination Therapies with Anti-angiogenesis agents:Anti-angiogenesis agents:

• With ChemotherapyWith Chemotherapy

• With RadiationWith Radiation

• With other anti-angiogenesis agentsWith other anti-angiogenesis agents

• With Vascular Disrupting AgentsWith Vascular Disrupting Agents

• Metronomic ChemotherapyMetronomic Chemotherapy

• Trimodal TherapyTrimodal Therapy

Into the Future…Into the Future…

• What are the limitations of these therapies?What are the limitations of these therapies?

• Can these agents work in all cancer sites?Can these agents work in all cancer sites?

• Could these agents be used for prevention of a Could these agents be used for prevention of a recurrent cancer (e.g. Breast CA)?recurrent cancer (e.g. Breast CA)?

• Will clinicians use these therapies?Will clinicians use these therapies?

• Over 50 angiogenesis inhibitors in ongoing clinical Over 50 angiogenesis inhibitors in ongoing clinical trialstrials

The bottom line…The bottom line…

•Angiogenesis inhibitors have Angiogenesis inhibitors have the potential to prolong the potential to prolong cancer patients’ cancer patients’ quantity quantity of of life without diminishing their life without diminishing their qualityquality of life of life

For more information:For more information:

• The American Cancer Society The American Cancer Society www.cancer.orgwww.cancer.org

• The National Cancer Institute The National Cancer Institute www.cancer.govwww.cancer.gov

Questions?Questions?

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