Management of hypertension in angiogenesis inhibitor-treated patients
Open Access
- 15 January 2009
- journal article
- review article
- Published by Elsevier BV in Annals Of Oncology
- Vol. 20 (5), 807-815
- https://doi.org/10.1093/annonc/mdn713
Abstract
Background: 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. Methods: 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. Results: 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. Conclusions: 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.This publication has 53 references indexed in Scilit:
- VEGF Inhibition and Renal Thrombotic MicroangiopathyNew England Journal of Medicine, 2008
- Paclitaxel plus Bevacizumab versus Paclitaxel Alone for Metastatic Breast CancerNew England Journal of Medicine, 2007
- Uncovering Pandora’s vase: the growing problem of new toxicities from novel anticancer agents. The case of sorafenib and sunitinibClinical and Experimental Medicine, 2007
- Bevacizumab plus interferon alfa-2a for treatment of metastatic renal cell carcinoma: a randomised, double-blind phase III trialThe Lancet, 2007
- Cardiotoxicity associated with tyrosine kinase inhibitor sunitinibThe Lancet, 2007
- Treatment of arterial hypertension (AHT) associated with angiogenesis inhibitorsAnnals Of Oncology, 2007
- Sorafenib in Advanced Clear-Cell Renal-Cell CarcinomaNew England Journal of Medicine, 2007
- Effect of Regular Phosphodiesterase Type 5 Inhibition in HypertensionHypertension, 2006
- Angiogenic growth factors and hypertensionAngiogenesis, 2004
- Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood PressureHypertension, 2003