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Angiogenesis Inhibitors: What to Know

Reviewed by Brunilda Nazario, MD on June 18, 2020

If you find out you have cancer, your health care team might mention a treatment using angiogenesis inhibitors. They may not get as much attention as other cancer therapies like immunotherapy or chemotherapy, but angiogenesis inhibitors can be a powerful addition to your cancer-fighting toolbox.

What Is Angiogenesis?

From time to time, your body needs to make new blood vessels, like when you grow or heal from a wound. Your body sends out chemical signals. These signals tell the cells that line the inside of your blood vessels to start sprouting new blood vessels. This process is angiogenesis.

It also plays a key role in cancer. For tumors to grow larger than a pinhead, they need blood to bring in food and oxygen and remove waste. The tumor sends out chemicals to tell your body to make new blood vessels. It can also tell nearby cells to send out signals too. These new blood vessels feed the tumor so it can grow and spread in your body.

What Are Angiogenesis Inhibitors?

Angiogenesis inhibitors battle cancer in a unique way. They don’t attack cancer cells directly. Instead, they strike a tumor’s blood supply. They block the growth of new blood vessels, so the tumor doesn't get the oxygen and nourishment it needs to grow. In some cases, the tumor may shrink.

These drugs target the signals that help the tumor get blood. They usually don’t harm normal cells in your body. The meds also aren't as likely to cause your body to start resisting the drug.

In some cases, these medicines work best in combination with other cancer-fighting treatments.

But they aren’t silver bullets. They only work in cancers with solid tumors. They don’t work for blood cancers like leukemia.

How They Work

Angiogenesis inhibitors interfere with the creation of blood vessels in three main ways.

Some drugs block blood vessel growth factors. The main growth factor in angiogenesis is vascular endothelial growth factor (VEGF). It binds to receptors on the cells of blood vessels and jump-starts the creation of new blood vessels. Some angiogenesis inhibitors find VEGF or other growth factors, then bind to them so they can’t do their job.

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The drugs that work this way are:

  • Bevacizumab (Avastin)
  • Ramucirumab (Cyramza)
  • Ziv-aflibercept (Zaltrap)

Other drugs jam up VEGF receptors. This stops them from sending signals to blood vessel cells. Without these signals, angiogenesis won’t start. Your doctor might call these drugs tyrosine kinase inhibitors.

Examples of these types of meds include:

  • Axitinib (Inlyta)
  • Cabozantinib (Cometriq)
  • Lenvatinib mesylate (Lenvima)
  • Pazopanib (Votrient)
  • Regorafenib (Stivarga)
  • Sorafenib (Nexavar)
  • Sunitinib (Sutent)
  • Vandetanib (Caprelsa)

Still other drugs interfere with the messages cells send to each other. This can block their activities and keep blood vessels from growing. These drugs include:

  • Everolimus (Afinitor)
  • Lenalidomide (Revlimid)
  • Thalidomide (Synovir, Thalomid)

Side Effects

Angiogenesis inhibitors can bring a variety of them. But not everyone has to deal with side effects. If you do, they tend to be milder than ones you might have with other cancer treatments.

Possible symptoms include:

  • High blood pressure
  • Diarrhea
  • Fatigue
  • Dry, itchy skin or a rash
  • Hand-foot syndrome, which can cause blisters on your palms or soles of your feet
  • Wounds that have trouble healing

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In rare cases, you could have more severe symptoms like:

If you feel any side effects, talk to your doctor about what you can do to ease them.

WebMD Medical Reference

Sources

SOURCES:

National Cancer Institute: “Angiogenesis Inhibitors.”

Dana-Farber Cancer Institute: “What is an Angiogenesis Inhibitor and How Can It Be Used to Treat Cancer.”

Johns Hopkins Medicine: “Angiogenesis Inhibitors.”

MD Anderson Cancer Center: “Angiogenesis Inhibitors.”

Cancer Research UK: “Drugs that block cancer blood vessel growth (anti angiogenics).”

Acta Ophthalmologica: “Ziv-aflibercept: A Cost-Effective, Off-Label, Highly Potent Antagonist of Vascular Endothelial Growth Factor.”

Medline Plus: “Lenvatinib.”

Cancer.net: “Angiogenesis and Angiogenesis Inhibitors to Treat Cancer.”

The Angiogenesis Foundation: “Treatments.”

 

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