ESMO E-Learning: Optimising Anti-Angiogenic Strategies in Gastric Adenocarcinoma

Learning Objectives

  • To provide an update on the mechanism and role of neoplastic Angiogenesis in the development, invasion and spread of gastric cancer
  • To provide an update on anti-angiogenic treatments and their side-effects in patients with advanced gastric cancer 
  • To provide an update of recent clinical studies with different anti-angiogenic drugs tested in patients with gastric cancer
Title Duration Content CME Points CME Test
Optimising Anti-angiogenic Strategies in Gastric Adenocarcinoma 22 min. 57 slides 1 Take Test
Christelle de la Fouchardière
Christelle de la Fouchardière
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Angiogenesis is the formation of new blood vessels from pre-existing vessels and is an essential process in malignant tumour growth, progression and metastasis. Angiogenesis plays a major role in the development and progression of gastric cancer. Despite some contradictory results, clinical data suggest that the inhibition of angiogenic signalling pathways has therapeutic potential in this type of cancer.

Inhibition of VEGF/VEGFR reduces tumour growth and vascularity in animal models of gastric adenocarcinoma. In patients with gastric cancer, circulating VEGF levels are associated with increased tumour aggressiveness and reduced survival.

The majority of anti-angiogenic treatments used in the clinic are based upon the inhibition of VEGF/VEGFR signalling. Monoclonal antibodies, soluble receptors, and small-molecule Tyrosine kinase inhibitors have been developed to inhibit tumour angiogenesis and several of these drugs have been tested in phase II studies in gastric cancer. Two drugs, ramucirumab and apatinib, have shown significant results in phase III trials.

Based on the positive results of the REGARD and RAINBOW trials, ramucirumab is the first anti-angiogenic treatment approved in advanced gastric cancer by the European Medicines Agency and the US Food and Drug Administration. Ramucirumab is indicated as second-line treatment, alone or in combination with paclitaxel, for patients with advanced or metastatic gastric or oesophagogastric junction cancers, who progressed on fluoropyrimidine- or platinum-containing first-line chemotherapy.

Apatinib has been approved by the China Food and Drug Administration and will certainly be evaluated in Western countries. Other anti-angiogenic treatments (ziv-aflibercept, pazopanib, dovitinib and others) are currently being evaluated in phase II studies and will probably represent new tools in the future management of patients with advanced gastric cancer. 

A general overview of angiogenesis signalling pathways is presented in this E-learning module, together with a focus on the role of these pathways in gastric cancer, the essential components of the pathways and modalities for inhibition. A list of anti-angiogenic drugs is given, along with their properties and the clinical studies conducted in patients with advanced gastric cancer.

Last update: 04 January 2016

The author has reported no conflict of interest.