Biomarker-Guided Strategies for Tumor Vasculature: From Imaging Advances to Novel Therapeutic Interventions

The tumor vasculature is a dynamic and heterogeneous component of the tumor microenvironment (TME) that influences tumor progression, immune infiltration, metastatic spread, and therapeutic response. This review explores the factors that contribute to the unique vascular characteristics of the TME, highlighting the potential for molecular and imaging biomarkers to predict treatment outcomes. We discuss structural and functional abnormalities of tumor vessels, including altered architecture, permeability, interstitial pressure, endothelial phenotype, and impaired drug delivery. We also examine angiogenic signaling through hypoxia-inducible factor 1 (HIF1) and vascular endothelial growth factor (VEGF), while highlighting non-angiogenic mechanisms such as vessel co-option. The review then turns to the current clinical landscape of angiogenesis, assessing the success and limitations of current therapies, emerging treatment strategies, biomarkers associated with angiogenesis, and AI-assisted prognostication. The establishment and clinical utilization of angiogenesis and tumor vasculature biomarkers is critical for disease diagnosis, prognosis, and the development of targeted therapies. This review aims to inform future innovation in personalizing oncological therapies that harness insights into the behavior of the tumor vasculature, enhancing the precision and effectiveness of cancer treatment.