Tumor Lymphangiogenesis as a Potential Therapeutic Target

Figure 4

Schematic for potential clinical strategies in treatment of metastatic disease. (A) Tumor progression can be evaluated based on several prognostic indicators including tumor lymphangiogenesis and sentinal LNs status. These steps will guide the therapeutic decision to adopt anti-lymphangiogenic strategies if the tumor appears to be lymphangiogenesis-dependent and/or to have lymph node metastasis. (B) Antiangiogenesis, anti-lymphangiogenesis, and chemotherapy can be applied to reduce tumor growth and restrict metastasis before surgery. For advanced disease or nonresectable tumors, there will be no surgery [171]. (C) Photodynamic therapy (PDT) also can be performed before removal of the primary tumor, to eradicate in-transit tumor cells and prevent tumor relapse. Anti-lymphangiogenic, antiangiogenic, and chemotherapy can also be applied later, to prevent tumor regrowth and metastasis. (D) Cancer recurrence can be monitored by checking sentinel LN status, lymphangiogenic and angiogenic growth factor levels. PDT, photodynamic therapy; LN, lymph node; LVD, lymphatic vessel density; GF, growth factor (adapted from [171]).