Antiangiogenic Treatment in Ovarian Cancer in the Era of Evidenced-Based Medicine.

Angiogenesis plays a major role in tumor growth and metastatic spread of cancer, and therefore inhibition of angiogenesis seems a promising therapeutic strategy. In order to grow beyond microscopic size, tumors need a better delivery of nutrients and oxygen so neovascularization must occur. Vascular endothelial growth factor [VEGF] pathway is the most important factor in promoting angiogenesis. This pathway may be blocked by either extracellular interference with VEGF itself (bevacizumab [BEV] or aflibercept), or intracytoplasmic inhibition of VEGF receptor (pazopanib, nintedanib, cediranib, sunitinib and sorafenib). Approximately 97% of ovarian tumors over express the VEGF ligand and this is correlated with early metastases, ascites formation and poor prognosis. The addition of antiangiogenic agents to standard chemotherapy in ovarian cancer is a rational therapeutic option for primary or recurrent ovarian carcinoma but it does not represent a new standard treatment until the subset of patients who benefit the most is identified.