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  • Print publication year: 2011
  • Online publication date: February 2014

10 - Antivascular therapy in gynaecological cancers

from SECTION 3 - IMAGING AND THERAPY: STATE OF THE ART

Summary

The great majority of women with advanced ovarian cancer will relapse and die from the disease. Angiogenesis is particularly relevant to ovarian cancer. Tumour vascular endothelial growth factor (VEGF) overexpression is associated with tumour angiogenesis, malignant progression and metastasis, ascites formation and early recurrence and death from the disease. Chemotherapy and vascular disrupting agents (VDAs) can cause mobilisation of bone marrow progenitor cells, including circulating endothelial progenitor cells (CEPs), which could theoretically increase angiogenesis. Two trials of combination therapy that included bevacizumab have suggested discrepancies between CA125 and RECIST response evaluation. VDAs selectively target pre-existing tumour vasculature, leading to rapid tumour cell ischaemia and death. The decrease in vascular tumour perfusion seen using dynamic contrast imaging suggests dynamic methods such as DCE-MRI, positron emission tomography-computed tomography (PET/CT) and MR spectroscopy in phase I and II trials may give an early indication of antivascular effect.