The development of ipilimumab (Yervoy) and its approval by the US Food and Drug Administration (FDA) in March 2011 have opened a new era in the treatment and management of patients with metastatic melanoma. The continued innovation in cancer drug development has been focused on a different mechanism of action that engages the patient’s own immune system in attacking malignancy in contrast to the more traditional myelosuppressive drugs that have been used in the past half century to kill rapidly dividing cancer cells.
Bevacizumab is a recombinant humanized monoclonal antibody that binds to vascular endothelial growth factor (VEGF)-A, inhibiting the activation of its receptors (FLT1 and KDR) on the surface of endothelial cells.1 This inhibition prevents the initiation of angiogenesis, which contributes to tumor growth and proliferation by providing a blood supply for malignant cells.2 Bevacizumab is US Food and Drug Administration approved for colorectal cancer, non–small-cell lung cancer (NSCLC), HER-2–negative breast cancer, glioblastoma, and renal-cell cancer. Some of the common adverse reactions of bevacizumab include hypertension, epistaxis, headache, rhinitis, stomatitis, asthenia, proteinuria, taste alteration, dry skin, rectal hemorrhage, back pain, and exfoliative dermatitis.1
There has recently been a paradigm shift in the treatment of patients with cancer. Traditionally, cancer chemotherapy has been given through the intravenous (IV) route. However, in the past 15 years, the number of available oral chemotherapeutic agents has more than doubled. In addition, approximately 30% to 35% of antineoplastics currently being developed are in an oral formulation.1 Oral formulations offer many advantages for patients, including convenience, potential for reduced side effects, and enhanced quality of life. Several studies have shown that between 63% and 89% of patients would prefer an oral therapy if efficacy were not compromised.2-4
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