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The role of vascular endothelial growth factor inhibitors in the treatment of epithelial ovarian cancer

British Journal of Cancer volume 126, pages 851–864 (2022)Cite this article

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Abstract

Advanced epithelial ovarian, fallopian tube and primary peritoneal cancers (EOC) are a leading cause of gynaecological cancer-associated mortality and angiogenesis plays a key role in their growth. Vascular endothelial growth factor inhibitors (VEGFi) disrupt angiogenesis and improve the response rate, progression-free survival and in some cases, overall survival, when administered with and following cytotoxic chemotherapy, irrespective of the platinum sensitivity of EOC. Recent data have identified new indications for VEGFi in EOC: repeated exposure to VEGFi in the first- and then second-line treatment has sustained clinical efficacy; combinations of VEGFi with poly (ADP-ribose) polymerase inhibitors (PARPi) have proven effective as first-line or second-line maintenance regimens. However, recent trial data have not shown improved outcomes with combinations of VEGFi and immune checkpoint inhibitors. There remains a critical need to optimise patient selection for these effective yet somewhat toxic and expensive treatments. The search continues for validated biomarkers to optimise the use of VEGFi, of which the most promising at present is plasma Tie2. Based upon these studies, we propose a model of care incorporating VEGFi into the treatment of EOC, highlighting the need to change from the prescription of single courses of VEGFi, to allow use and re-use as clinically indicated.

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Fig. 1: Optimal first-line systemic treatment of advanced epithelial ovarian cancer.
Fig. 2: Optimal systemic treatment of progressive or recurrent epithelial ovarian cancer.

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  1. The Christie NHS Foundation Trust, Manchester, M20 4BX, UK

    Alexander D. Murphy, Robert D. Morgan, Andrew R. Clamp & Gordon C. Jayson

  2. Division of Cancer Sciences, Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK

    Robert D. Morgan, Andrew R. Clamp & Gordon C. Jayson

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AM and GJ contributed to conceptualisation and outline. AM, GJ, AC and RM contributed to the manuscript preparation and review.

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Murphy, A.D., Morgan, R.D., Clamp, A.R. et al. The role of vascular endothelial growth factor inhibitors in the treatment of epithelial ovarian cancer. Br J Cancer 126, 851–864 (2022). https://doi.org/10.1038/s41416-021-01605-5

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