Emerging Novel Therapies in Recurrent Ovarian Cancer: Anti-angiogenesis

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E Pujade-Lauraine

Hong Kong J Radiol 2013;16(Suppl):S4-8

Ovarian cancer is the leading cause of gynaecological cancer death in Hong Kong. It is often diagnosed late due to the absence of a means for routine screening. Up to 75% of patients relapse in spite of good initial response to platinum therapy. The patient response to chemotherapy in recurrent ovarian cancer can be predicted by the length of the platinum-free interval. Following relapse, chemotherapy is the standard of care, with response rates typically in the range of 17 to 31%; however, there have been few advances in chemotherapeutic agents in recent years. In comparison, an increasing number of anti-angiogenesis agents have been developed and investigated, based on the rationale that vascular endothelial growth factor (VEGF) — the driving force behind angiogenesis — is implicated in all stages of pathogenesis in ovarian cancer. Bevacizumab is a recombinant humanised monoclonal antibody of the immunoglobulin G1 isotype with high specificity and affinity for VEGF, resulting in potent VEGF-neutralising activity. It was the first anti-angiogenesis agent to be tested in ovarian cancer in phase III randomised clinical trials, both as first-line (GOG128 and ICON7) and second-line therapy (AURELIA and OCEANS). These trials demonstrated definitively the activity of bevacizumab in ovarian cancer, proving the concept that anti-angiogenesis is a viable and effective treatment option in ovarian cancer. Other classes of antiangiogenesis agents currently under investigation that have shown early promise include the VEGF receptor / multi-target tyrosine kinase inhibitors and anti-angiopoietins.




E Pujade-Lauraine