Antivascular

Antivascular describes strategies and agents that interfere with the growth or function of blood vessels, with particular emphasis on abnormal vasculature in disease. The term encompasses both approaches that prevent the formation of new vessels (anti-angiogenic therapies) and approaches that disrupt existing vasculature (vascular-disrupting agents).

Anti-angiogenic therapies primarily target the vascular endothelial growth factor (VEGF) pathway or related angiogenic signals. Examples include monoclonal antibodies such as bevacizumab; soluble decoys like aflibercept; and receptor tyrosine kinase inhibitors such as sunitinib, sorafenib, and pazopanib. Vascular-disrupting agents aim to damage established tumor vessels; examples include combretastatin derivatives (CA4P) and other agents studied for rapid vascular collapse. The overarching goal is to reduce tumor blood supply, thereby slowing growth or enhancing the effectiveness of other treatments.

In ophthalmology, antivascular therapy suppresses pathological retinal neovascularization and edema. Intravitreal anti-VEGF agents such as ranibizumab, bevacizumab, and aflibercept are routinely used to treat age-related macular degeneration, diabetic retinopathy, and retinal vein occlusion, demonstrating how antivascular strategies can mitigate abnormal ocular vessel growth.

Clinical considerations include potential resistance and the concept of vascular normalization, where combination strategies aim to improve delivery of accompanying therapies. Adverse effects can include hypertension, thromboembolism, wound-healing impairment, and, in ocular use, risks such as infection or retinal ischemia, requiring careful patient selection and monitoring.