Review
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Jul 15, 2015; 7(7): 71-86
Published online Jul 15, 2015. doi: 10.4251/wjgo.v7.i7.71
Anti-angiogenic agents in metastatic colorectal cancer
Bhavana Konda, Helen Shum, Lakshmi Rajdev
Bhavana Konda, Helen Shum, Lakshmi Rajdev, Department of Medical Oncology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY 10461, United States
Author contributions: Konda B, Shum H and Rajdev L made substantial contributions to conception and design of the manuscript, drafting the article and making critical revisions related to important intellectual content of the manuscript, and final approval of the version of the article to be published.
Conflict-of-interest statement: Bhavana Konda, Helen Shum, and Lakshmi Rajdev have no conflicts of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Lakshmi Rajdev, MD, Department of Medical Oncology, Albert Einstein College of Medicine/Montefiore Medical Center, 1695 Eastchester Road, Bronx, NY 10461, United States. lrajdev@montefiore.org
Telephone: +1-718-4058404 Fax: +1-718-4058433
Received: February 4, 2015
Peer-review started: February 5, 2015
First decision: April 10, 2015
Revised: May 13, 2015
Accepted: June 1, 2015
Article in press: June 2, 2015
Published online: July 15, 2015
Abstract

Colorectal cancer (CRC) is a major public health concern being the third leading cause of cancer mortality in the United States. The availability of better therapeutic options has led to a decline in cancer mortality in these patients. Surgical resection should be considered in all stages of the disease. The use of conversion therapy has made surgery a potentially curative option even in patients with initially unresectable metastatic disease. In this review we discuss the role of various anti-angiogenic agents in patients with metastatic CRC (mCRC). We describe the mechanism of action of these agents, and the rationale for their use in combination with chemotherapy. We also review important clinical studies that have evaluated the safety and efficacy of these agents in mCRC patients. Despite the discovery of several promising anti-angiogenic agents, mCRC remains an incurable disease with a median overall survival of just over 2 years in patients exposed to all available treatment regimens. Further insights into tumor biology and tumor microenvironment may help improve outcomes in these patients.

Keywords: Anti-angiogenic agents, Metastatic colorectal cancer, Targeted agents, Conversion therapy, Colorectal metastasectomy

Core tip: Colorectal cancer is a major health concern and a leading cause of cancer mortality worldwide. New innovations have provided improved survival in recent years. In this review, we outline the novel anti-angiogenic agents and their respective roles in metastatic colorectal cancer. In addition to three agents approved by the Food and Drug Administration, several alternative anti-angiogenic agents hold promise for use in the metastatic setting.