Book Review

Tumor Angiogenesis: Basic Mechanisms and Cancer Therapy

N Engl J Med 2008; 358:2416May 29, 2008

Article

Tumor Angiogenesis: Basic Mechanisms and Cancer Therapy
Edited by Dieter Marmé and Norbert Fusenig. 845 pp., illustrated. Berlin, Springer, 2008. $369. ISBN: 978-3-540-33176-6

In January, the world lost a visionary in cancer research, M. Judah Folkman. Folkman, who died while traveling to a Keystone symposium to give the keynote address, proposed nearly four decades ago that attacking the tumor vasculature could improve outcomes for patients with cancer in its advanced stages. These insights provided the foundation for the development of antiangiogenic therapies and changed the standard of care for patients with specific cancers (as well as for patients with ocular macular degeneration). It is fitting that this book, Tumor Angiogenesis, begins with a chapter written by Folkman in which he comprehensively reviews the evolution of the field and gives insights on the transition from bench to bedside.

The chapters in Tumor Angiogenesis are divided into four sections: “Historical Overview,” “Mechanisms,” “Animal Models and Preclinical Anti-Angiogenic Studies,” and “Anti-Angiogenic Tumor Therapy in Clinical Studies.” All the authors are outstanding contributors to the field, but the authors of the chapters in the earlier sections of the book, in particular, helped define the field; it is a tribute to the book's editors that they were able to recruit such prestigious contributors. Although most of the major topics in angiogenesis research are addressed, there is no chapter on the complexities of the Notch–Notch ligand system, which was recently identified as an angiogenic target. But it is not possible for a large textbook to be completely current in a rapidly evolving field.

The final section of the book addresses antiangiogenic tumor therapy in clinical studies. There are now many completed and ongoing phase 3 trials of antiangiogenic therapies, either alone or in combination with chemotherapy. The editors chose to base the chapters in this section on individual agents, rather than on disease types. This approach overemphasizes select drugs, some whose benefit has been proved and some whose benefit remains to be determined. It may overlook the potential of the more than 30 other antiangiogenic agents in clinical development, some of which are currently in phase 3 trials. An approach based on the site of the disease might have provided more insight, since the efficacy of this class of agents varies greatly among different types of cancer.

The chapters are nicely illustrated, and color figures are included within each chapter instead of in a separate section of all color plates, as is often done in books of this kind. Another nice touch is that each chapter has a short abstract introducing the reader to the topic at hand. There is a small amount of overlap between the chapters, but for the most part this is acceptable because the authors provide different views and perspectives on the topics.

Tumor Angiogenesis is an outstanding overview of the basic science and translational aspects of angiogenesis. Nevertheless, we still have a lot to learn. We do not have any predictive markers of efficacy, and the life-prolonging benefit of antiangiogenic therapy is, for the most part, incremental. To fully capitalize on antiangiogenic therapy, we must continue to have an open dialogue between basic scientists and clinical investigators. This book will serve that purpose, not only for graduate students and new investigators in the field, but also for experienced investigators.

Lee M. Ellis, M.D.
University of Texas M.D. Anderson Cancer Center, Houston, TX 77030
lellis@mdanderson.org