Dr. Rugo on Antiangiogenic Therapies in Breast Cancer

Hope S. Rugo, MD, professor of medicine and director of breast oncology and clinical trials education at the University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, provides an update on clinical trials that are investigating antiangiogenic therapeutics for patients with advanced breast cancer.

Rugo is anticipating the results from several phase III trials currently investigating the antiangiogenic therapy bevacizumab (Avastin). The first is the ECOG 5103 trial that is studying doxorubicin, cyclophosphamide, and paclitaxel with or without bevacizumab. This trial began in November 2007 making patient stratification by current standards difficult. Despite this, Rugo remains optimistic that a subset analysis will be possible to find a subpopulation that benefits from the addition of bevacizumab.

The second phase III trial is the MERiDIAN trial, which is investigating bevacizumab in patients stratified by plasma VEGF-A levels. This trial hopes to discover a predictive biomarker for the use of bevacizumab and Rugo believes it will help bring bevacizumab back into the treatment paradigm for patients with advanced breast cancer.

Rugo notes that other antiangiogenic therapies are currently being studied in addition to bevacizumab.

The phase III RESILIENCE trial is comparing capecitabine plus sorafenib to capecitabine and placebo for patients with advanced breast cancer. Another placebo-controlled phase III trial is examining the antiangiogenic agent ramucirumab plus docetaxel in locally recurrent or metastatic breast cancer. Rugo expects results from this study to be presented at the San Antonio Breast Cancer Symposium in December. Additionally, early-stage trials are investigating angiopoietin-targeted agents, which can decrease angiogenesis.

Overall, the field of antiangiogenic therapies for patients with breast cancer continues to thrive, despite the setbacks received with bevacizumab.