Management of hypertension in angiogenesis inhibitor-treated patients

• Published in: Annals of oncology Vol. 20; no. 5; pp. 807 - 815
• Main Authors: Izzedine, H., Ederhy, S., Goldwasser, F., Soria, J.C., Milano, G., Cohen, A., Khayat, D., Spano, J.P.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.05.2009; Oxford University Press; Oxford Publishing Limited (England)
• Subjects: angiogenesis inhibitors; Angiogenesis Inhibitors - adverse effects; anti-VEGF agents; Antihypertensive Agents - therapeutic use; Antineoplastic agents; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Blood and lymphatic vessels; Blood Pressure - drug effects; Cardiology. Vascular system; drug; Humans; Hypertension - chemically induced; Hypertension - drug therapy; Hypertension - physiopathology; hypertension management; Medical sciences; Neoplasms - drug therapy; Neoplasms - metabolism; Patient Selection; Pharmacology. Drug treatments; Practice Guidelines as Topic; Risk Assessment; Risk Reduction Behavior; Severity of Illness Index; Signal Transduction - drug effects; Vascular Endothelial Growth Factor A - antagonists & inhibitors; hypertension management; angiogenesis inhibitors; anti-VEGF agents; drug; Human; Hypertension; Drug; Cardiovascular disease; Patient; Management; Clinical management; Treatment; Anti-VEGF; Antiangiogenic agent
• DOI: 10.1093/annonc/mdn713
• ISSN: 0923-7534; 1569-8041

Hypertension (HTN) is one of the most frequent side-effects of systemic inhibition of vascular endothelial growth factor (VEGF) signaling. Its incidence and severity are dependent on the type of drugs, dose, and schedule used. The recognition of this side-effect is an important issue because poorly controlled HTN could lead to serious cardiovascular events. On another hand, HTN induced by anti-VEGF agents maybe a predictive factor of oncologic response. Knowledge of this clinical toxicity and/or therapeutic target or novel biomarker of drug activity can aid clinicians choosing the optimal and least toxic regimen suitable for an individual patient. A Medline search was carried out using the following criteria: (i) all Medline listings as of 1 January 2000 with abstracts, (ii) English language, and (iii) Humans. The following phrases were used to query the database: (‘hypertension’, OR ‘blood pressure’) AND (‘anti-VEGF’ OR ‘VEGF inhibition’ OR ‘bevacizumab’ OR ‘sunitinib’ OR ‘sorafenib’ OR ‘VEGF Trap’). The references of each article identified were carefully reviewed for additional reference. Lifestyle modification should be encouraged. However, these nonpharmacologic strategies are not always suitable to patients with altered performance status related to metastatic cancer necessitating early drug intervention. Only one randomized study showed a beneficial effect of a calcium channel blocker use to prevent or minimize HTN secondary to antiangiogenic therapy. Nitrates looks as effective in controlling such side-effect. No clear recommendation for an antihypertensive agent can be made in this context because there is a lack of controlled studies addressing the subject. Blood pressure-lowering drugs should be individualized to the patient's clinical circumstances and angiogenic inhibitors should be withheld only from patients who experienced hypertensive crisis.