Antiangiogenic therapies in ovarian cancer

Angiogenesis plays a pivotal role in normal ovarian physiology as well as in the formation and progression of ovarian cancer. Several well-designed phase II and III trials studied the efficacy of antiangiogenic agents in advanced ovarian cancer. The results of these trials demonstrated significantly prolonged progression-free survival when antiangiogenic agents were used as a maintenance therapy. To date, no effect on overall survival could be ascertained. The most widely studied antiangiogenic agent, bevacizumab - a monoclonal humanized antibody against vascular endothelial growth factor - was effective in all phases of the disease (first-line therapy, platinum-sensitive and platinum-resistant recurrence). These results led to regulatory approval in many countries including the European Union. Other anti-VEGF agents such as tyrosine kinase inhibitors have not shown increased activity but increased toxicity relative to bevacizumab. Agents targeting angiopoietin-1 and -2 are in development and new combinations with PARP inhibitors and immune checkpoint inhibitors are studied. This review summarizes the current data and knowledge on the clinical use of antiangiogenic agents in advanced ovarian cancer.