A review of VEGF/VEGFR-targeted therapeutics for recurrent glioblastoma.

Glioblastoma, the most common primary malignant brain tumor among adults, is a highly angiogenic and deadly tumor. Angiogenesis in glioblastoma, driven by hypoxia-dependent and independent mechanisms, is primarily mediated by vascular endothelial growth factor (VEGF), and generates blood vessels with distinctive features. The outcome for patients with recurrent glioblastoma is poor because of ineffective therapies. However, recent encouraging rates of radiographic response and progression-free survival, and adequate safety, led the FDA to grant accelerated approval of bevacizumab, a humanized monoclonal antibody against VEGF, for the treatment of recurrent glioblastoma in May 2009. These results have triggered significant interest in additional antiangiogenic agents and therapeutic strategies for patients with both recurrent and newly diagnosed glioblastoma. Given the potent antipermeability effect of VEGF inhibitors, the Radiologic Assessment in Neuro-Oncology (RANO) criteria were recently implemented to better assess response among patients with glioblastoma. Although bevacizumab improves survival and quality of life, eventual tumor progression is the norm. Better understanding of resistance mechanisms to VEGF inhibitors and identification of effective therapy after bevacizumab progression are currently a critical need for patients with glioblastoma.

Duke Scholars

Author Darell Doty Bigner Neurosurgery

Author Katherine Barnett Peters Neurosurgery, Neuro-Oncology

Author Annick Desjardins Neurosurgery, Neuro-Oncology

Author John Howard Sampson Neurosurgery

Author Roger Edwin McLendon Pathology

Author James Emmett Herndon II Biostatistics & Bioinformatics, Division of Biostatistics

Author John P. Kirkpatrick Radiation Oncology

Author Allan Howard Friedman Neurosurgery

Author Henry Seth Friedman Neurosurgery, Neuro-Oncology