VEGF inhibitors

Question 1

Angiogenesis (reference only)

Answer 1

Question 2

Bevacizumab (Avastin)

Answer 2

• First monoclonal antibody to receive approval
• Targets VEGF-A
• Intraocular and IV injection

Question 3

Aflibercept (Zaltrap)

Answer 3

• Marketed as a VEGF trap, this fusion protein selectively binds to VEGF-A, VEGF-B and PLGF

Question 4

Ramucirumab (Cyramza)

Answer 4

• Monoclonal antibody targeting VEGFR2

Question 5

Partially selective Tyrosine kinase inhibitors

Answer 5

• Sorafenib (Nexavar)
• Sunitinib (Sutent)
• Regorafenib (Stivarga)
• Pazopanib (Votrient)
• Axitinib (Inlyta)
• Vandetanib (Caprelsa)
• Lenvatinib (Lenvima)
• Cabozantinib (Cometriq)
  *

Question 6

Role of VEGF

Answer 6

• Key molecule of immunosupression
• Led to some promising uses of combination therapies employing anti-angiogenics and immunotherapy

Question 7

WET ARMD treatment

Answer 7

Bevacizumab

Wet macular degeneration

Question 8

Bevacizumab (Avastin)

Indication and dosing

Adverse effects

Answer 8

Indication and dose

• Neovascular ARMD: 1.25mg intravitreal qmo; prn after three doses
• Diabetic macular edema: off label
• Various metastatic cancers

Adverse effects

• Ocular
  
  • Subconjunctival heme
  • pain
  • vitreous floaters / detatchment
  • corneal edema
  • inflammation
  • visual disturbances
  • infection
  • cataracts
  • retinal tears or detatchment
  • ocular hypertension or hypotony

Contraindications

• Ocular surface infection