Antiangiogenic Therapy and Ovarian Cancer

Epithelial ovarian cancer is the most lethal of gynecologic malignancies in the United States and while current therapies are successful for many years, cure remains elusive. Angiogenesis is the physiological process of new blood vessel growth, and a normal process in growth, development, and wound healing. However, angiogenesis is also a fundamental step in the transition of tumors from a dormant state to a malignant state. Preclinical data and preliminary clinical data suggest that antiangiogenic therapy targeting the vascular endothelial growth factor (VEGF) pathway will change the natural history of epithelial ovarian cancer. With a proven survival advantage in a growing number of tumor types, antiangiogenenic therapy is an exciting field. Important questions remain: the mechanism of activity, optimal integration with chemotherapy, and the benefits and risks of targeting multiple pathways, these are being addressed through a series of clinical trials, designed to evaluate the tumor microenvironment and surrogate endpoints, such as wound healing, leading to a more rationale triaging of patients to this potentially dangerous and costly therapy. The scientific background, and clinical trials with novel agents are reviewed in this exciting new paradigm of care.