Gynecologic cancer

Abstract

Angiogenesis is required for cancer growth. To promote vascular sprouting, an angiogenic switch is flipped that up-regulates factors such as vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF), and angiopoietins, and down-regulates antiangiogenic factors such as thrombospondin-1 and angiostatin. Accumulating evidence supports the concept that angiogenesis plays a central role in ovarian and cervical carcinogenesis and disease progression. Two phase III randomized trials have been published that evaluated the addition of bevacizumab to standard chemotherapy as the front-line treatment of advanced ovarian cancer. Additional trials have evaluated the combination of bevacizumab with chemotherapy in platinum-sensitive and platinum-resistant recurrent disease. All these trials showed a statistically significant improvement in progression-free survival (PFS), although no improvement in overall survival (OS) has been reported. Based on these data, bevacizumab was recently approved for the treatment of ovarian cancer in Japan and Europe. Bevacizumab plus chemotherapy significantly improves the OS in patients with stage IV B, recurrent or persistent cervical carcinoma. The improvement in OS with bevacizumab treatment was not accompanied by a decrease in the quality of life (QOL). Bevacizumab is the first targeted agent to improve OS in gynecologic cancer.