|
| Mechanism of action | Current evidence |
|
| VEGF-mediated | | |
|
| Aflibercept (VEGF-Trap) | Soluble receptor which binds VEGF-A and-B as well as placenta-derived growth factor (PlGF) 1 and 2 | Preliminary results reported by a Phase II trial conducted in recurrent setting showed similar results than bevacizumab, with a remarkable less incidence of bowel perforation (1%) [18] |
| A phase III trial is ongoing |
|
| Cediranib | Small molecule that inhibits the tyrosine kinase domain of the VEFG receptor (VEGFR) | Two phase II trials in relapsing EOC demonstrated a response rate of nearly 20%, increasing up to 30% if disease stabilization is considered [19, 20] |
| Other members of this family are sorafenib and sunitinib | ICON 6, a phase III trial in recurrent platinum-sensitive patients, is now testing this agent in combination with carboplatin and paclitaxel |
|
| Sorafenib | Multitargeted TKI that inhibits raf kinase, VEGFR-2, VEGFR-3, Flt-3, c-kit, and platelet-derived growth factor receptor (PDGFR) | Phase I trial reported that 50% of patients showed stable disease [21]. Early data from a subsequent phase II study testing the combination of sorafenib with gemcitabine in recurrent EOC confirmed encouraging activity, with an overall response rate of 33% [22] |
| Several other phase II trials employing sorafenib either in front-line, maintenance phase, or recurrent settings, alone or in combination with standard chemotherapy or biologics (e.g., bevacizumab) are underway |
| A randomized phase III trial is currently evaluating Sorafenib as a maintenance therapy after first-line treatment in EOC |
|
| Pazopanib | Oral tyrosine kinase inhibitor that targets VEGFR, PDGFR, and c-kit | Preliminary results of a phase II trial conducted in recurrent EOC defined by CA-125 elevation showed a biochemical response of 47%, with stable disease observed in other 27% [23] |
| A phase III trial is currently evaluating pazopanib as a maintenance therapy after first-line treatment in EOC |
|
| Non VEGF-mediated | | |
|
| Vascular disrupting agents (VDAs) | Represent a new approach to deprive tumor from its blood supply, by causing the collapse of the established tumor vasculature. Their main targets are the endothelial cells | Preclinical data indicate that these drugs can improve tumor response to chemotherapy [24], radiation, and other Antiangiogenic therapies |
| Examples include tubulin destabilizers and flavanoids, among others | Zweifel and coworkers presented recently the final results of a phase II trial employing Fosbretabulin (a tubulin binder) along with carboplatin and paclitaxel in platinum-resistant EOC, revealing a response rate of 32% [25] |
|
