Update on Biomarkers in Development of Anti-angiogenic Drugs in Gastric Cancer.

The treatment of advanced gastric cancer remains challenging as the outcomes achieved with surgery alone or adjuvant or neoadjuvant chemotherapy and radiotherapy are poor. New treatment strategies are emerging and being tested in advanced gastric cancer. Vascular endothelial growth factor (VEGF) inhibitors have been confirmed as important therapeutic agents in randomised clinical trials in multiple solid tumour settings. Until now, results of phase II and phase III clinical trials of anti-angiogenic agents on gastric cancer have been relatively modest, with moderate improvement in overall survival. The effects of these drugs are limited due to development of resistance to them and the increased risk of tumour invasion and metastasis. If we are to optimise or develop combination regimens for advanced gastric cancer with VEGF inhibitors that build on their efficacy, it is critical to identify and validate biomarkers in order to enable selection of those patients who are prone to benefit and monitor their response to the drugs. Validated biomarkers can help to further personalise VEGF inhibitors and dosage determination for advanced or metastatic gastric cancer, particularly as these drugs can be toxic and expensive. Although no biomarker is validated for routine use for this purpose, several candidates are currently under investigation. In this review, we aim to give an overview of the recent developments in biomarkers for anti-angiogenic therapy in gastric cancer tumour angiogenesis.