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Hypoxia\u2010induced angiogenic signalling sustains tumour growth and shapes an immunosuppressive tumour microenvironment, while homologous recombination deficiency (HRD) has been associated with increased tumour hypoxia and pro\u2010angiogenic signalling. Conversely, VEGF pathway inhibition may exacerbate DNA damage and modulate immune cell trafficking, providing a strong biological rationale for synergy between anti\u2010angiogenic agents, PARP inhibitors (PARPi), and immune checkpoint inhibitors. Bevacizumab, a humanised monoclonal antibody targeting VEGF\u2010A, represents a pivotal therapeutic agent in OC management by inhibiting tumour angiogenesis and inducing transient vascular normalisation. Its clinical efficacy has been demonstrated as maintenance therapy in the first\u2010line setting, alone or in combination with PARPi for HRD\u2010positive disease, and in the recurrent setting both in platinum\u2010sensitive and platinum\u2010resistant disease. Despite these benefits, variability in patient response highlights the unmet need for validated predictive biomarkers. Circulating, tissue\u2010based and molecular biomarkers have been investigated, including angiogenic factors (Tie2\/Ang1 axis, interleukin\u20106 [IL\u20106] and chitinase\u20103\u2010like protein [YKL\u201040]), VEGF\u2010A isoforms, microvessel density, EGFR\/ADAM17 signalling, angiomiRs and transcriptional subtypes with mesenchymal and proliferative phenotypes showing greater sensitivity to anti\u2010angiogenic strategies. Although HRD status holds prognostic relevance and selected microRNAs show emerging potential, no biomarker has yet been validated to predict benefit from bevacizumab in clinical practice. Translational analyses from the MITO16A\/MaNGO OV\u20102 program, highlight challenges such as assay standardisation, multiplicity correction and external validation, while identifying tumour immune infiltration patterns, TP53 mutation classes and composite HRD assessments as areas of further investigation. In conclusion, bevacizumab remains an integral component of OC treatment. Future progress will depend on biomarker\u2010driven, prospectively designed clinical trials and the integration of multi\u2010omic data and machine learning approaches to enable precision application of anti\u2010angiogenic strategies, maximising clinical benefit while minimising toxicity.<\/jats:p>","DOI":"10.1002\/ctm2.70591","type":"journal-article","created":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T09:45:40Z","timestamp":1768038340000},"source":"Crossref","is-referenced-by-count":7,"title":["Bevacizumab in ovarian cancer: Clinical data and predictive and prognostic biomarkers"],"prefix":"10.1002","volume":"16","author":[{"given":"Maria Rosaria","family":"Lamia","sequence":"first","affiliation":[{"name":"Department of Clinical Medicine and Surgery University Federico II  Naples Italy"},{"name":"Department of Urology and Gynecology Istituto Nazionale Tumori IRCCS Fondazione G Pascale  Naples 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