Brain metastases account for more than 50% of all brain tumors. The incidence of brain metastases has been increasing in recent years, with better imaging studies and with the improvement of cancer directed therapies. Growth and survival of tumor cells depend largely on angiogenesis and the development of adequate blood supply. Bevacizumab is a humanized monoclonal antibody against vascular endothelial growth factor used to treat different types of solid tumors; however, due to concerns for intracerebral hemorrhage, patients with brain metastases were not included in initial trials. In recent years, several trials studied the efficacy and safety of bevacizumab and other vascular endothelial growth factor inhibitors have shown promising results in patients with brain metastases. Significant advances have been made for non-small cell lung cancer that is the most lethal cancer and the cancer that most commonly metastasizes to the brain. Melanoma has also shown good responses to these therapies. There are small case series about the use of anti-angiogenesis therapy in renal cell carcinoma, colorectal carcinoma, hepatocellular carcinoma and other malignancies. The treatment for central nervous system metastases is slowly evolving, and the hopes of better response, and eventually improvement in survival, are increasingly anticipated.
We present an updated review of the literature discussing the most recent applications and safety of anti-angiogenesis treatment in patient with brain metastases.

Keywords:
Bevacizumab, brain metastases, lung cancer, VEGF, angiogenesis, antiangiogenic therapy.