Glioblastoma is the most common and malignant primary brain tumour in adults. Maximum feasible surgical resection, radiotherapy and temozolomide chemotherapy at initial diagnosis have improved prognosis but rapid recurrence is typical and survival remains brief. There is an urgent need for effective new treatments and approval of the antiangiogenic agent bevacizumab for recurrent glioblastoma by Health Canada in 2009 has been the most notable recent therapeutic advance for this disease. This review with illustrative case studies highlights how bevacizumab has been incorporated into the treatment of glioblastoma in Canada and describes the ongoing controversies surrounding its clinical application.

Cancer treatment using the antiangiogenic agents targets the evolution of the tumor vasculature. The aim is to significantly reduce supplies of oxygen and nutrients, and thus starve the tumor and induce its regression. In the paper we consider well established family of tumor angiogenesis models together with their recently proposed modification, that increases accuracy in the case of treatment using VEGF antibodies. We consider the optimal control problem of minimizing the tumor volume when the maximal admissible drug dose (the total amount of used drug) and the final level of vascularization are also taken into account. We investigate the solution of that problem for a fixed therapy duration. We show that the optimal strategy consists of the drug-free, full-dose and singular (with intermediate values of the control variable) intervals. Moreover, no bang-bang switch of the control is possible, that is the change from the no-dose to full-dose protocol (or in opposite direction) occurs on the interval with the singular control. For two particular models, proposed by Hahnfeldt et al. and Ergun et al., we provide additional theorems about the optimal control structure. We investigate the optimal controls numerically using the customized software written in MATLAB®, which we make freely available for download. Utilized numerical scheme is based on the composition of the well known gradient and shooting methods.

Angiogenesis, or new vessel formation, plays a key role in the process of tumor growth and metastasis in breast cancer. Recent large phase-III trials (E2100 and AVADO) demonstrate the clinical utility of bevacizumab in combination with front-line taxane-based chemotherapy in patients with metastatic breast cancer, leading to its recent approval in the United States and Europe. Several other anti-angiogenic strategies against vascular endothelial growth factor are in various phases of clinical development. This paper reviews the data on bevacizumab in metastatic breast cancer and other anti-angiogenic strategies on development in breast cancer.