The concept of angiogenesis and anti-angiogenesis is probably one of the most important advances in our assessment of physiopathological processes and also an example of progress in our understanding of physiological development. It is for this
reason that the decision was made nearly 4 years ago to devote one of the Institut Servier meetings to this topic, particularly as it covers the majority of medical disciplines and can be considered as what is nowadays known as a transversal theme.
Although the potential use of an anti-angiogenic treatment for cancer was ἀrst mentioned by Folkman nearly 37 years ago (1971), it is in the last 5 years that therapeutic trials in two opposing domains have multiplied:
––use of pro-angiogenic medications in ischemic disease, mainly critical lower-limb ischemia and coronary disease, with the as yet unconἀrmed hope of blocking the process of restenosis after angioplasty and/or stent implantation;
––use of anti-angiogenic therapies in the treatment of cancer, with three drugs currently available: bevacizumab (Avastin ®), sorafenib, imitinib). Particularly in metastatic renal cancer, the achievements are unquestionable, with successful albeit less spectacular results in colorectal cancer, non-small cell lung cancer, and hepatocellular carcinoma. Although the activity of anti-angiogenic agents in monotherapy is not to be discounted, it proves most interesting when coupled with chemotherapy.
The mechanism of angiogenesis is as follows: it functions just as well in disease situations as in healthy adults by awakening quiescent endothelial cells, thus promoting neovascularisation. An example is that of extended muscular exercise where local hypoxia, resulting from an increase in local oxygen consumption, is compensated by capillarogenesis.