Hypoxia caused by inhibition of angiogenesis, upregulates VEGFA expression, contributing to aggressive disease recurrence.16, 17 VEGFA was recently shown to increase tumor-initiating stem cell abundance in skin18 and breast cancers,19, 20 and in glioblastoma.21, 22 The high local VEGFA induced by hypoxia following bevacizumab treatment would thus also promote expansion of the tumor cell subset with the greatest ability to initiate and disseminate tumors. The gene discussed is VEGFA; the disease is breast carcinoma.