Angiogenesis describes the sprouting of new blood vessels from preexisting
vascular networks. A tightly regulated balance between pro- and antiangiogenic
factors regulates this process, which can be disrupted under pathological
conditions. Tumor development is characterized by an “angiogenic switch”, which
results in an increase in expression of pro-angiogenic factors such as vascular endothelial
growth factor (VEGF) and concomitant repression of angiogenesis inhibitors such as thrombospondin-
1 (TSP-1). Overexpression of pro-angiogenic factors promotes the rapid formation of
tumor vasculature, which typically is hyperpermeable, convoluted, and lacks normal perivascular
cell interactions. This disorganized vasculature results in reduced tumor perfusion, which can significantly
impair drug delivery to the tumor. Ovarian cancer is typically not detected until late stage
and can present a therapeutic challenge, due to the presence of a large, poorly-vascularized tumor.
The prevalence of chemoresistance in ovarian cancer has spurred recent research into alternative
therapeutic targets for this disease. Various anti-angiogenic approaches have been studied, including
targeting VEGF expression and restoring expression of anti-angiogenic factors such as TSP-1.
Studies using anti-angiogenic treatments have demonstrated the preferential destruction of immature,
dysfunctional blood vessels, with the preservation of healthy, parental vasculature. The vessel
normalization induced by anti-angiogenic therapy has been found to improve tumor perfusion, facilitate
uptake of chemotherapeutic compounds and is associated with tumor regression even in advanced
stage ovarian cancer. The purpose of this review is to examine the pathological angiogenic
processes that characterize tumor growth, evaluate the efficacy of anti-angiogenic therapies, and
discuss the process and therapeutic implications of vessel normalization in the context of antiangiogenic
therapies for advanced stage ovarian cancer.