title: Clinical results of randomized trials and 'real-world' data exploring the impact of Bevacizumab for breast cancer: opportunities for clinical practice and perspectives for research.
abstract: Angiogenesis plays a fundamental role in breast cancer (BC) growth, progression and metastatic spread. After the promising introduction of bevacizumab for the treatment of advanced BC, the initial enthusiasm decreased when the FDA withdrew its approval in 2011. Nevertheless, several clinical studies exploring the role of bevacizumab have been subsequently published. Areas covered: The aim of this study is to review the available clinical trials exploring the potential effectiveness of bevacizumab in BC, regardless of the disease setting. Expert opinion: Even if the evidence suggests that bevacizumab must be ruled out from the HER2-positive and adjuvant setting, bevacizumab's benefit remains uncertain in the neoadjuvant setting and in the advanced treatment of HER2-negative patients. In the first setting, the addition of bevacizumab to chemotherapy increased the pathological complete response (pCR) rate in most clinical trials. However, the current absence of evidence that pCR is a trial-level surrogate for survival requires waiting for long-term results. In the advanced setting, all trials showed a benefit in progression-free survival, but not in overall survival, highlighting an increase of adverse events. The lack of predictors of response represents the main unmet need in which future clinical research will undoubtedly invest.
authors.affiliation: a U.O. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata , Verona , Italy.|b Breast Unit, Azienda Ospedaliera Universitaria Integrata , Verona , Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Zambonin
authors.affiliation: a U.O. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata , Verona , Italy.|b Breast Unit, Azienda Ospedaliera Universitaria Integrata , Verona , Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: De Toma
authors.affiliation: a U.O. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata , Verona , Italy.|b Breast Unit, Azienda Ospedaliera Universitaria Integrata , Verona , Italy.
authors.forename: Luisa
authors.initials: L
authors.lastname: Carbognin
authors.affiliation: a U.O. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata , Verona , Italy.|b Breast Unit, Azienda Ospedaliera Universitaria Integrata , Verona , Italy.
authors.forename: Rolando
authors.initials: R
authors.lastname: Nortilli
authors.affiliation: a U.O. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata , Verona , Italy.|b Breast Unit, Azienda Ospedaliera Universitaria Integrata , Verona , Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Fiorio
authors.affiliation: a U.O. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata , Verona , Italy.|b Breast Unit, Azienda Ospedaliera Universitaria Integrata , Verona , Italy.
authors.forename: Veronica
authors.initials: V
authors.lastname: Parolin
authors.affiliation: a U.O. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata , Verona , Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Pilotto
authors.affiliation: c Agenzia Italiana del Farmaco , Roma , Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Cuppone
authors.affiliation: b Breast Unit, Azienda Ospedaliera Universitaria Integrata , Verona , Italy.|d Chirurgia Senologica, Azienda Ospedaliera Universitaria Integrata, A.O.U.I. Breast Surgery Verona , Verona , Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Pellini
authors.affiliation: b Breast Unit, Azienda Ospedaliera Universitaria Integrata , Verona , Italy.|d Chirurgia Senologica, Azienda Ospedaliera Universitaria Integrata, A.O.U.I. Breast Surgery Verona , Verona , Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Lombardi
authors.affiliation: b Breast Unit, Azienda Ospedaliera Universitaria Integrata , Verona , Italy.|d Chirurgia Senologica, Azienda Ospedaliera Universitaria Integrata, A.O.U.I. Breast Surgery Verona , Verona , Italy.
authors.forename: Giovanni Paolo
authors.initials: GP
authors.lastname: Pollini
authors.affiliation: a U.O. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata , Verona , Italy.|b Breast Unit, Azienda Ospedaliera Universitaria Integrata , Verona , Italy.
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Tortora
authors.affiliation: a U.O. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata , Verona , Italy.|b Breast Unit, Azienda Ospedaliera Universitaria Integrata , Verona , Italy.
authors.forename: Emilio
authors.initials: E
authors.lastname: Bria
mesh_terms: D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D000818:Animals; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D000068258:Bevacizumab / Q000627:therapeutic use*; D035843:Biomedical Research / Q000379:methods* / Q000639:trends; D001943:Breast Neoplasms / Q000175:diagnosis / Q000188:drug therapy*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D020360:Neoadjuvant Therapy / Q000379:methods; D009389:Neovascularization, Pathologic / Q000175:diagnosis / Q000188:drug therapy; D064792:Pragmatic Clinical Trials as Topic / Q000379:methods*; D016032:Randomized Controlled Trials as Topic / Q000379:methods
chemical_list: D020533:Angiogenesis Inhibitors; D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab
keywords: Angiogenesis; bevacizumab; breast cancer; clinical trials; review