What Are Angiogenesis Inhibitors?
Angiogenesis inhibitors, also called anti-angiogenesis inhibitors, are a type of targeted therapy for mesothelioma. These drugs are designed to interfere with the process of angiogenesis — the formation of new blood vessels — that mesothelioma tumors depend on to grow and spread.
There are two main types of angiogenesis inhibitors:
- Monoclonal antibodies: Lab-made proteins that stick to cancer cells and block signals that help tumors grow new blood vessels
- Small molecule drugs: Tiny drugs that go inside cancer cells and block signals that help new blood vessels grow
Specialists may use these drugs on their own or in combination with chemotherapy drugs like pemetrexed (Alimta®) and cisplatin. When combined, the therapies work together to more effectively destroy mesothelioma cells. Chemotherapy damages the cancer cells directly, while angiogenesis inhibitors block their ability to sustain themselves.
Anti-angiogenesis inhibitors are most often used in patients with pleural mesothelioma, a type of this cancer that affects the lung lining. They are also being studied in clinical trials for peritoneal mesothelioma, which affects the abdominal lining.
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How Do Angiogenesis Inhibitor Drugs Treat Mesothelioma?
Your body naturally forms new blood vessels to heal wounds and maintain healthy tissues. Mesothelioma takes advantage of this process to feed itself. Angiogenesis inhibitors block the cancer’s ability to grow new blood vessels.
Here’s how they work:
- Stop growth signals: Tumor cells release proteins that tell nearby blood vessels to grow toward them. Angiogenesis inhibitors block those proteins so the message never gets through.
- Reduce the tumor’s fuel supply: Because fewer blood vessels reach the cancer, it receives less oxygen and nutrients.
- Support other treatments: With fewer blood vessels, chemotherapy and radiation can sometimes reach the tumor more effectively.
Instead of directly destroying mesothelioma cells, these drugs weaken the tumor’s support system. This makes it harder for the cancer to spread and can give other treatments a better chance to work.
Types of Mesothelioma Anti-Angiogenesis Inhibitors
There are different types of anti-angiogenesis medicines used or being studied to treat mesothelioma. Each works in its own way to block the signals that help tumors grow new blood vessels and stay alive.
Bevacizumab (Avastin®)
Bevacizumab, known by the brand name Avastin, is the best-known angiogenesis inhibitor used in mesothelioma treatment. It targets a protein called VEGF (vascular endothelial growth factor). VEGF acts like a signal telling the body to grow new blood vessels around a tumor. Avastin attaches to that protein and blocks it, which can starve the cancer by stopping those vessels from forming.
“Avastin is a VEGF inhibitor that tries to block new blood vessel growth that’s feeding the cancer. It tries to stop that part in its tracks. It’s an important part to consider adding to chemotherapy in certain patients.”
Doctors may add Avastin to chemotherapy drugs such as pemetrexed (Alimta®) and cisplatin for people with pleural mesothelioma. In the MAPS phase III trial, adding bevacizumab to chemotherapy increased overall survival to 18.8 months compared with 16.1 months for chemotherapy alone. This combination also kept the cancer from coming back for about 2 months longer.
Nintedanib (Ofev®)
Nintedanib blocks VEGF, PDGF (platelet-derived growth factor), and FGF (fibroblast growth factor). By turning off these signals, nintedanib limits the blood and nutrients reaching the tumor, which can slow mesothelioma growth and help other treatments work better.
In the phase II LUME-Meso trial, doctors studied nintedanib with standard chemotherapy for people who hadn’t received treatment yet. Patients with the epithelioid cell type of malignant pleural mesothelioma lived a median of 20.6 months on nintedanib plus chemotherapy compared with 15.2 months on chemotherapy alone.
Doctors may offer nintedanib through clinical trials or in off-label cases for pleural mesothelioma, especially for patients who prefer a pill-based treatment or who cannot receive other treatments. Ongoing research continues to explore how best to combine it with other targeted therapies and immunotherapies.
Sunitinib (Sutent®)
Sunitinib blocks VEGF receptors (which help new blood vessels grow), PDGF receptors (which help support those vessels), and KIT (a protein that helps cancer cells grow and divide).
Doctors have studied sunitinib in people with pleural mesothelioma whose cancer returned after chemotherapy. In a small study, some patients’ tumors stopped growing or even got smaller for a time. While the results were modest, they showed that sunitinib might help control mesothelioma in some cases.
Sunitinib isn’t approved by the U.S. Food and Drug Administration (FDA) for mesothelioma, but it can sometimes be used in clinical trials for people who have already tried standard treatments. The drug is taken as a pill, and doctors monitor patients closely for side effects such as tiredness, high blood pressure, and stomach problems.
Combining Small Molecule Drugs with Other Mesothelioma Treatments
Most doctors use angiogenesis inhibitors as part of a larger treatment plan rather than by themselves. This approach is called multimodal therapy, meaning several treatments work together to fight the cancer.
Angiogenesis inhibitors are commonly combined with:
- Chemotherapy: Adding Avastin to chemotherapy may improve survival and reduce tumor size.
- Immunotherapy: Controlling blood vessel growth can help immune system cells reach the tumor more easily, making drugs like nivolumab (Opdivo®) or ipilimumab (Yervoy®) more effective.
- Radiation: Some studies suggest that reducing a tumor’s blood supply can make solid tumors more sensitive to radiation therapy.
Your care team will consider your overall health and treatment goals to find the safest and most effective combination for you.
Download our Free Doctor Questions Checklist to prepare for your next appointment and discuss treatment combinations that might fit your situation.
Side Effects of Angiogenesis Inhibitors
Like all cancer treatments, anti-angiogenesis inhibitors can cause side effects, but they are usually manageable. Because these drugs affect blood vessels, most side effects are related to circulation or healing.
Possible side effects of anti-angiogenesis inhibitors include:
- Digestive discomfort
- Fatigue
- High blood pressure
- Mild bleeding or bruising
- Slower wound healing
Your mesothelioma care team will monitor you closely and adjust your medication if needed. Always tell your doctor about new symptoms, even small ones. Managing side effects early helps keep treatment on track and protects your overall health.
Some people with heart or blood vessel problems may not be good candidates for angiogenesis inhibitors. Your doctor will review your medical history to make sure this type of therapy is safe for you.
Clinical Trials Testing Anti-Angiogenesis Inhibitors for Mesothelioma
Researchers are continuing to study whether drugs that block blood-vessel growth can help people with mesothelioma live longer or keep their cancer under control. Several promising anti-angiogenesis inhibitors are being tested in clinical trials for mesothelioma.
Examples include:
- Bevacizumab + atezolizumab with chemotherapy: This large study, known as BEAT-Meso, tested whether adding immunotherapy (atezolizumab) to chemotherapy and bevacizumab could help people with pleural mesothelioma live longer. Some patients — especially those with non-epithelioid cell types — saw better results with the combination.
- Nivolumab + ramucirumab: A phase II trial found that pairing ramucirumab (a VEGFR-2 blocker) with immunotherapy (nivolumab) helped many patients whose mesothelioma came back after chemotherapy, offering disease control and manageable side effects.
- Bevacizumab + chemotherapy ± immunotherapy: An ongoing NCI-sponsored study is testing chemotherapy and bevacizumab with or without atezolizumab to see whether adding immunotherapy improves survival for patients with peritoneal mesothelioma.
- Sintilimab + bevacizumab + chemotherapy: A newer phase II trial is currently enrolling patients to test whether combining sintilimab (immunotherapy), bevacizumab, and chemotherapy can shrink or slow tumor growth.
If you’re interested in exploring angiogenesis inhibitors, connecting with an experienced mesothelioma specialist is the best next step. They can review your medical history, explain which new options are available for your diagnosis, and help you find open clinical trials.
Use our Free Doctor Match to connect with mesothelioma specialists and find out whether you may be eligible to join a clinical trial.
Learn if Angiogenesis Inhibitors for Cancer Could Help You
Angiogenesis inhibitors like bevacizumab have shown meaningful results for some people with pleural mesothelioma. While not a cure, they can slow disease progression and improve how long patients live with this cancer.
You may be eligible to receive an angiogenesis inhibitor after a mesothelioma diagnosis, depending on your cancer type, stage, and overall health. Your mesothelioma specialist can determine whether these drugs could be part of your personalized treatment plan.
Mesothelioma Hope’s Patient Advocates can also help you by:
- Connecting you with top mesothelioma doctors and treatment centers
- Helping you understand treatment options and side effects
- Matching you with nearby clinical trials for anti-angiogenesis inhibitors
- Sharing financial assistance resources for medical and travel costs
Call (866) 608-8933 to reach our team or use our Free Doctor Match to find the right specialist for your diagnosis.
Angiogenesis Inhibitors Drugs for Mesothelioma FAQs
How do angiogenesis inhibitors treat cancer?
Angiogenesis inhibitors treat mesothelioma cancer by cutting off the tumor’s blood supply. Mesothelioma needs oxygen and nutrients to grow and spread. These medicines block a signal called VEGF (vascular endothelial growth factor), which tells the body to create new blood vessels around the tumor.
By stopping that signal, drugs such as bevacizumab (Avastin®) and nintedanib (Ofev®) can slow the growth of mesothelioma tumors and make them easier to control.
Doctors often combine angiogenesis inhibitors with chemotherapy drugs like pemetrexed (Alimta®) and cisplatin to improve results and help patients breathe more comfortably. This approach gives people living with mesothelioma another way to manage the disease and maintain quality of life.
What are the FDA-approved angiogenesis inhibitors?
At this time, there aren’t any angiogenesis inhibitors approved by the U.S. Food and Drug Administration (FDA) specifically for mesothelioma. However, doctors can use certain approved drugs off-label if research supports their safety and effectiveness.
Bevacizumab (Avastin) is the most common angiogenesis inhibitor used this way. It’s FDA-approved for several cancers, including lung and colon cancer, but studies show it can also help some people with pleural mesothelioma live longer when combined with chemotherapy.
If you’re unsure whether angiogenesis inhibitors could be part of your treatment plan, our nurses and Patient Advocates can walk you through your options and help you talk with a mesothelioma specialist. Contact us today to get started.
What are the side effects of anti-angiogenesis treatment?
Most mesothelioma patients tolerate anti-angiogenesis inhibitors well, but side effects can happen because these drugs affect blood vessels and circulation.
Common side effects include tiredness, mild bleeding or bruising, high blood pressure, and slower wound healing. These issues are usually manageable, especially with regular checkups and good communication with your care team.
Your doctor will monitor you throughout mesothelioma treatment to keep you safe. Blood pressure checks and blood tests are routine. Serious side effects, like internal bleeding or blood clots, are uncommon but can happen. Be sure to tell your doctor about any new symptoms or health problems right away so your treatment can be adjusted if needed.
What drugs are angiogenesis inhibitors?
The most common angiogenesis inhibitors used or studied for mesothelioma include bevacizumab (Avastin) and nintedanib (Ofev).
Each of these drugs works slightly differently, but they all aim to block the signals that help tumors grow new blood vessels. Your mesothelioma specialist will decide whether one of these medicines fits your treatment plan based on your type of mesothelioma, your overall health, and your goals for care.
What are natural angiogenesis inhibitors?
Some foods and plant compounds such as green tea, turmeric (curcumin), and grapes (resveratrol) have been shown to slightly reduce blood vessel growth.
However, these effects haven’t been proven to stop or slow mesothelioma in people. They can be healthy parts of a balanced mesothelioma diet, but they shouldn’t be used as a replacement for medical treatment.
It’s always best to talk with your doctor before taking any vitamins, herbs, or supplements during treatment. Some natural products can interfere with cancer medicines. A registered dietitian or oncology nurse can help you find safe, nutritious ways to support your health during therapy.
Are angiogenesis inhibitors the same as small-molecule cancer drugs?
No. Angiogenesis inhibitors are a group of drugs that block blood vessel growth, while small-molecule drugs are a broader category of medicines that can enter cells to target specific proteins.
Some angiogenesis inhibitors, such as nintedanib (Ofev®) or sunitinib (Sutent®), are small molecules. Others, like bevacizumab (Avastin®), are larger antibody-based drugs.
Your doctor can explain which type you’re receiving and how it works in your body. Both can help slow mesothelioma growth, but they target cancer cells in different ways.
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