Role of angiogenesis inhibitors in cancer treatment.

Angiogenesis is essential for the growth of both primary and metastatic tumors. This process, more complex than was previously thought, requires the coordinated activities of multiple factors and cell types. For tumors to develop a neovascular blood supply, tumor and host cells must secrete pro-angiogenic factors that offset the activities of inhibitory angiogenic factors. In addition, the newly derived tumor endothelium must respond to survive in a relatively caustic microenvironment. Thus, endothelial-cell survival factors are essential in the maintenance of this neovasculature. Because redundant factors and pathways regulate angiogenesis, inhibition of any single pathway is unlikely to lead to prolonged response in most patients with solid malignancies. Since anti-angiogenic therapy is unlikely to induce tumor regression, the criteria for efficacy must be evaluated by means other than the standard criteria used to evaluate cytotoxic chemotherapy regimens. Understanding the basic principles that drive tumor angiogenesis will lead to the development of therapies that will likely prolong survival without the toxicity associated with standard chemotherapy.