Review Antiangiogenic therapy and surgical practice A. R. John1,2,S.R.Bramhall1 andM.C.Eggo2 1Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust, and 2Division of Medical Sciences, The Medical School, University of Birmingham, Birmingham, UK Correspondence to: Mr A. R. John, Division of Medical Sciences, The Medical School, University of Birmingham, Birmingham B15 2TT, UK (e-mail:
[email protected]) Background: Antiangiogenic therapy has become a reality with the recent introduction of bevacizumab, a monoclonal antibody against vascular endothelial growth factor. Methods: Relevant medical literature from PubMed, National Institute for Health and Clinical Excellence and National Institutes of Health websites to August 2007 was reviewed. Results and conclusions: Although often described as the fourth modality of treatment after surgery, radiotherapy and chemotherapy, many antiangiogenic drugs have failed to live up to expectations. Nevertheless, research continues and there are reasons to believe that antiangiogenic therapy may yet have a future in the clinical setting. Paper accepted 31 October 2007 Published online in Wiley InterScience (www.bjs.co.uk). DOI: 10.1002/bjs.6108 Introduction of EGFR will inhibit the growth of the tumour cells directly and inhibition of VEGFR will inhibit angiogenesis. Other The term angiogenesis, defined as the sprouting of new receptors that are targeted include platelet-derived growth vessels from pre-existing vasculature, was first used by factor receptor, fibroblast growth factor receptor 1 and John Hunter in 1787 when describing the growth of blood rearranged during transfection (RET) tyrosine kinase. vessels in a reindeer antler. It is only recently, however, Also shown in Table 1 is bevacizumab, a humanized form that its importance in reproduction, development, wound of a monoclonal antibody to VEGF, that binds to VEGF healing and various disease states has been recognized.