Dual EGFR-VEGF Pathway Inhibition: A Promising Strategy for Patients With EGFR-Mutant NSCLC.

Abstract

The VEGF pathway has been recognized as a key mediator of angiogenesis to support tumorigenesis. Multiple therapeutic agents targeting VEGF and VEGF receptors have been developed and approved for use in NSCLCs. Preclinical studies have found that the VEGF and EGFR pathways share common downstream signaling, and these pathways can function exclusively of one another during oncogenesis. In EGFR-mutant NSCLCs, up-regulated EGFR signaling increases VEGF through hypoxia-independent mechanisms, and elevated VEGF, in turn, contributes to the emergence of resistance to EGFR tyrosine kinase inhibitors (TKIs). In clinical trials, the addition of anti-VEGF therapy to EGFR TKIs considerably improved clinical outcomes. In recently reported large randomized studies, the addition of bevacizumab or ramucirumab to EGFR TKIs substantially improved progression-free survival in patients with TKI-naive EGFR-mutant NSCLC. This article reviews the preclinical and clinical data supporting dual inhibition of EGFR and VEGF in EGFR-mutant NSCLC as a way to improve patient outcomes.

• Authors: Xiuning Le, Monique Nilsson, Jonathan Goldman, Martin Reck, Kazuhiko Nakagawa, Terafumi Kato, Luis Paz Ares, Bente Frimodt-Moller, Katharina Wolff, Carla Visseren-Grul, John V Heymach, Edward B Garon
• Journal: Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer (J Thorac Oncol) Vol. 16 Issue 2 Pg. 205-215 (02 2021) ISSN: 1556-1380 [Electronic] United States
• PMID: 33096270 (Publication Type: Journal Article, Review)
• Copyright: Copyright © 2020 International Association for the Study of Lung Cancer. Published by Elsevier Inc. All rights reserved.

Chemical References

• Protein Kinase Inhibitors
• Vascular Endothelial Growth Factor A
• EGFR protein, human
• ErbB Receptors

Topics

• Carcinoma, Non-Small-Cell Lung (drug therapy, genetics)
• Drug Resistance, Neoplasm
• ErbB Receptors (genetics)
• Humans
• Lung Neoplasms (drug therapy, genetics)
• Mutation
• Protein Kinase Inhibitors (pharmacology, therapeutic use)
• Vascular Endothelial Growth Factor A