Antiangiogenic Therapy in NSCLC

H. Jack West, MD: I think one of the interesting and challenging things about antiangiogenic therapy is that we aren’t entirely sure how these agents work in practice. There are preclinical data that suggest that these agents help to prune the blood supply to the tumor and can lead to a limitation of growth and, potentially, some shrinkage of the cancer. But in addition, it actually changes the blood supply so that agents given with the antiangiogenic agents are delivered more effectively. It can increase oxygenation to the tumor. All of this can lead to a greater killing effect of the cancer when given in combination with a cytotoxic agent.

Antiangiogenic therapy can be in the form of monoclonal antibodies, given as intravenous therapy, or as oral small molecules—tyrosine kinase inhibitors. The ones in the setting of advanced non—small cell lung cancer that have been best studied are the monoclonal antibodies. We have bevacizumab, ramucirumab, and there are also some small molecules like necitumumab. At this point, in the United States, we really have not adopted necitumumab, though there are data to support using it in previously treated patients. It is FDA approved in Europe. We need to better clarify if there are significant differences in efficacy, tolerability. Overall, they have more similarities than differences, I would say, in broad strokes.