Bevacizumab treatment for cancer patients with cardiovascular disease: A double edged sword?

Recently, bevacizumab, the novel humanized monoclonal antibody directed against vascular endothelial growth factor (VEGF), has shown promising preclinical and clinical anti-cancer activity. However, concerns have been raised regarding a possible increased risk for arterial thrombo-embolic events associated with its administration, especially in patients with pre-existing cardiovascular disease. On the other hand, bevacizumab treatment is associated with an increased bleeding risk that may be augmented by the co-administration of anti-platelet drugs such as aspirin and clopidogrel. In this paper, we present the available data, identify controversies and unresolved issues, and suggest solutions regarding the administration of bevacizumab to cancer patients with cardiovascular disease.