Antiangiogenic therapy and ovarian cancer

Epithelial ovarian cancer is the most lethal of gynecologic malignancies in the United States and while current therapies e 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.