Perry Lucas¹, Bailey Ella², Young Ava³, Hill Lucas⁴, Robinson Mia⁵, Hill Henry⁶, Scott Emily⁷, Bennett Zoe⁸, Mitchell Isla⁹
ABSTRACT:
Anti-vascular endothelial growth factor (VEGF) therapies have revolutionized the management of ocular neovascular disorders and multiple cancers. However, interpatient variability in treatment response and the emergence of resistance remain significant challenges. This review synthesizes current knowledge on predictive biomarkers of anti-VEGF response, encompassing genetic polymorphisms (e.g., VEGF-A, CFH), circulating proteins (VEGF, PlGF), imaging biomarkers (OCT metrics), and tumor microenvironment signatures (immune cell infiltration, hypoxia markers). We highlight mechanistic insights into resistance pathways, including VEGF-independent angiogenesis and endothelial-mesenchymal transition, and discuss emerging strategies to overcome resistance through biomarker-guided combination therapies. The integration of multi-omics data and artificial intelligence for patient stratification is explored as a path toward personalized anti-angiogenic treatment.