Ongoing trials with bevacizumab and other antiangiogenic agents in lung cancer.

The recent approval of bevacizumab, sunitinib, and sorafenib in a number of diseases has led to significant interest in expanding the role of antiangiogenic therapies in cancer. Specifically, bevacizumab has only received approval for a relatively selective population with advanced non-squamous non-small-cell lung cancer (NSCLC) with good performance status and without coagulopathy, brain metastases, or hemoptysis. This has significantly restricted the potential benefit bevacizumab can bring to patients with lung cancer. In order to address whether bevacizumab might be beneficial in other settings, a multitude of clinical trials are ongoing. These include questions such as the safety of bevacizumab in patients with hemoptysis, brain metastases, and squamous cell histology. The use of bevacizumab is also being addressed in locally advanced and early-stage lung cancer. The results of many of these trials will be available in the next 2-3 years. Unfortunately, as in the case of many targeted therapies, we lack a specific biomarker to predict response to these agents. In addition, although antiangiogenic trials are well under way in NSCLC, this is not the case for small-cell lung cancer, a highly angiogenic disease in which the pace of research is substantially slower.