Some patients consider oral drugs to be more convenient than intravenous fusions. Currently, no oral antiangiogenic agents are FDA approved for brain cancer, but a number are being tested in clinical trials. One of these, cediranib (Recentin^®), showed positive activity as a single agent in a clinical study of 30 patients with relapsed glioblastoma.⁷ Fifty percent of patients experienced either shrinkage of their tumor or halting of its growth during treatment. Further, many patients who initially required steroid therapy were able to have their steroid doses reduced, and several were able to come off these drugs altogether. Cediranib is now being studied in combination with other drugs for brain cancer.

Another promising antiangiogenic agent under investigation is cilengitide. This drug targets specific molecules in cells called integrins that play a key role in both angiogenesis and the growth of tumor cells.⁸ Cilengitide has shown activity in clinical studies in both relapsed and previously untreated brain cancer. Like the drug temozolomide, cilengitide appears to work particularly well in patients whose brain cancers have a particular genetic feature called a methylated methylguanine methyltransferase (MGMT) promoter, which occurs in about half of all glioblastoma cases. In patients with an MGMT promoter, the cancer cell’s DNA is unable to repair itself when damaged. A large clinical trial is underway to test how well cilengitide works in combination with temozolomide and radiation therapy, in previously untreated glioblastoma patients with methylated MGMT promoter gene status.