Antiangiogéniques en cancérologie thoracique : critères de prescription et gestion des effets indésirables

Abstract

The only anti-angiogenic registered drug in first-line treatment of metastatic, nonsquamous non-small cell lung cancer (NSCLC) is the humanized monoclonal anti-VEFG antibody, bevacizumab, of which registration phase 3 trial is still a seminal date in history of stage IV NSCLC treatments. Indeed, in this trial for the first time, the bevacizumab-containing triplet led to an overall survival exceeding one year. If other anti-angiogenic drugs also obtained a European registration in second line setting, in combination with docetaxel (nintedanib and ramucirumab), whereas other did not obtain such registration because of negative phase 3 trials or excessing toxicity, their action, by targeting the main angiogenesis signaling pathway (VEGF or VEGF-R), is responsible for commune adverse, more or less, marked ≪ class ≫ effects, and explain commune restrictions in their indications, needing to carefully select the patients able to be treated with such drugs. Bevacizumab still remains the best model of description of these use restrictions and of these class side effects, such as systemic hypertension, hemorrhages, thrombosis or proteinuria. Furthermore, bevacizumab indications could be extended in thoracic oncology to pleural mesothelioma, because of the positivity of the MAPS randomized phase 3 trial sponsored by French Intergroup (IFCT). Thus, the rigorous patient selection has decreased the main complications incidence allowing for the use of bevacizumab, as upfront treatment with or without maintenance, for a large number of metastatic nonsquamous NSCLC patients.