Angiogenesis: prognostic and therapeutic implications in gynecologic and breast malignancies.
OBJECTIVE
Growth, invasion and metastasis of malignant tumors depend on angiogenesis, which is therefore considered an attractive therapeutic target and indicator of clinical outcome. Summarizing the results of very recent studies, we discuss the clinical relevance of vascularization of breast and gynecological tumors.


RESULTS
The prognostic values of directly assessed vascularity (microvessel density) and angiogenic factors have been confirmed for these malignancies, despite few contradictory results that may be due to methodological inaccuracy. In addition, many studies point to a role of angiogenesis as a predictor of response to both antiangiogenic and conventional chemotherapy or radiotherapy. For a conclusive evaluation, however, further studies covering all clinically relevant subgroups of patients are needed. Novel therapeutic approaches with inhibitors of angiogenesis are promising, although the adaptation of most experimentally proven approaches to clinical practice appears to be a laborious process. Furthermore, for an appropriate clinical evaluation of these drugs, newly defined endpoints of treatment and new monitoring systems reflecting their mode of action and the anticipated biological effects are required.


CONCLUSIONS
The prognostic and predictive value of angiogenic factors and microvessel density has been confirmed. Antiangiogenic therapy will most likely play an important role in future clinical management of malignant diseases.
Sauer
Georg
G
Department of Gynecology and Obstetrics, University of Ulm Medical School, Germany. georg.sauer@medizin.uni-ulm.de
Deissler
Helmut
H
D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D043168:Angiostatins; D001707:Biopsy, Needle; D001943:Breast Neoplasms / Q000098:blood supply* / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D005833:Genital Neoplasms, Female / Q000098:blood supply* / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D009367:Neoplasm Staging; D009389:Neovascularization, Pathologic / Q000188:drug therapy* / Q000503:physiopathology; D010446:Peptide Fragments / Q000627:therapeutic use; D010958:Plasminogen / Q000627:therapeutic use; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D019699:Thrombospondins / Q000627:therapeutic use; D016896:Treatment Outcome
D020533:Angiogenesis Inhibitors; D010446:Peptide Fragments; D019699:Thrombospondins; D043168:Angiostatins; D010958:Plasminogen