title: The role of bevacizumab in colorectal cancer: understanding its benefits and limitations.
abstract: BACKGROUND
  Angiogenesis is a key factor in the development of aberrant blood vessels required for malignant growth, invasion and progression. Inhibiting VEGF is by far the most clinically advanced anti-angiogenic target. Bevacizumab (BV), the only humanized mAb directed against VEGF, is approved for use in multiple tumor types after successful clinical trial results demonstrated benefits in progression-free survival and/or overall survival when combined with common cytotoxic chemotherapies.
  
  
  METHODS
  The review focuses on the use of BV in colorectal cancer, discusses the clinical trial data supporting its increasing use and explores its limitations. Readers will gain a succinct description of the trial data demonstrating a modest survival benefit in metastatic colorectal cancer (mCRC) and the lack of benefit of BV when utilized in the adjuvant setting. A review of common BV toxicities and a discussion about possible BV resistance mechanisms are also provided.
  
  
  CONCLUSIONS
  Although BV has demonstrated efficacy in mCRC, there is an urgent need to improve the understanding of its mechanism of action and the development of BV resistance. Furthermore, there is a need for delineating predictive markers of BV efficacy and toxicity.
authors.affiliation: Cross Cancer Institute, Department of Medical Oncology, 11560 University Avenue, Edmonton, Alberta, Canada. Karen.Mulder@albertahealthservices.ca
authors.forename: Karen
authors.initials: K
authors.lastname: Mulder
authors.forename: Andrew
authors.initials: A
authors.lastname: Scarfe
authors.forename: Neil
authors.initials: N
authors.lastname: Chua
authors.forename: Jennifer
authors.initials: J
authors.lastname: Spratlin
mesh_terms: D020533:Angiogenesis Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D000818:Animals; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab; D017024:Chemotherapy, Adjuvant; D015179:Colorectal Neoplasms / Q000098:blood supply / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery; D019008:Drug Resistance, Neoplasm; D019317:Evidence-Based Medicine; D006801:Humans; D009389:Neovascularization, Pathologic / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab