title: Update on bevacizumab and other angiogenesis inhibitors for brain cancer.
abstract: BACKGROUND
  Primary and metastatic brain tumors remain a major challenge. The most common primary adult malignant brain tumor, glioblastoma (GBM), confers a dismal prognosis as does the development of CNS metastases for most systemic malignancies. Anti-angiogenic therapy has been a major clinical research focus in neuro-oncology over the past 5 years.
  
  
  METHODS
  Culmination of this work includes US FDA accelerated approval of bevacizumab for recurrent GBM and the completion of two placebo-controlled Phase III studies of bevacizumab for newly diagnosed GBM. A multitude of anti-angiogenics are in evaluation for neuro-oncology patients but none has thus far surpassed the therapeutic benefit of bevacizumab.
  
  
  CONCLUSIONS
  These agents demonstrate adequate safety and the majority of GBM patients derive benefit. Furthermore, their anti-permeability effect can substantially decrease tumor-associated edema leading to stable or improved neurologic function and quality of life. In particular, anti-angiogenics significantly prolong progression-free survival - a noteworthy achievement in the context of infiltrative and destructive brain tumors like GBM; however, in a manner analogous to other cancers, their impact on overall survival for GBM patients is modest at best. Despite substantial clinical research efforts, many fundamental questions regarding anti-angiogenic agents in brain tumor patients remain unanswered.
authors.affiliation: Dana-Farber/Brigham and Women's Cancer Center, Center for Neuro-Oncology, Boston, MA, USA.
authors.forename: Mikael L
authors.initials: ML
authors.lastname: Rinne
authors.forename: Eudocia Q
authors.initials: EQ
authors.lastname: Lee
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Nayak
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Norden
authors.forename: Rameen
authors.initials: R
authors.lastname: Beroukhim
authors.forename: Patrick Y
authors.initials: PY
authors.lastname: Wen
authors.forename: David A
authors.initials: DA
authors.lastname: Reardon
mesh_terms: D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000068258:Bevacizumab; D001932:Brain Neoplasms / Q000188:drug therapy*; D005909:Glioblastoma / Q000188:drug therapy; D006801:Humans
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab