Targeting angiogenesis in the treatment of hepatic metastasis

The liver is the most common site for the development of metastases from gastrointestinal malignancies. Although the only potentially curative option for patients with liver metastases is resection, only a minority are candidates. In order to increase the number of patients who may be candidates for resection, preoperative systemic chemotherapy and targeted therapy approaches have been utilized. Angiogenesis has been shown to be integral for the growth and metastasis of many tumor types including the development of liver metastases. The development of antiangiogenic approaches, particularly anti vascular endothelial growth factor (VEGF) therapy with bevacizumab, has shown great promise in the treatment of patients with liver metastases, particularly from colorectal cancer and to a lesser degree, neuroendocrine carcinoma. These approaches have allowed physicians to increase the number of patients that may be amenable for curative resection. As angiogenesis and VEGF have been shown to be important in liver hypertrophy and regeneration, however, the possible effects of anti-VEGF therapy on liver recovery may carry significant risks along with the potential benefits.