Bevacizumab resistance in breast cancer: are neuropilins the key?

During breast cancer growth and development, angiogenesis is triggered by the interaction between vascular endothelial growth factor (VEGF) and its receptors VEGF-R1 and VEGF-R2. In breast cancer, alternative VEGF receptors, the neuropilins (Np1 and Np2), are often upregulated and serve to augment the effects of VEGF-R1/VEGF-R2 binding and provide alternative signalling pathways. Recently, a humanized antibody, Bevacizumab (Bz), which prevents VEGF binding to VEGF-R1/VEGF-R2, in combination with chemotherapy demonstrated initial efficacy (increased progression-free survival) in breast cancer phase III clinical trials. Eventually, however, the tumours evade treatment control. This may be because neuropilins are not blocked by Bz and provide an alternative VEGF signalling pathway in breast cancer. Therefore the present study aims to evaluate the potential of enhancing efficacy of Bz treatment by simultaneously blocking VEGF–neuropilin binding.