Anti-VEGF Anticancer Drugs: Mind the Hypertension
News release date: March 24, 2016
Katsi, Vasiliki; Ioannis, Zerdes; Stavroula, Manolakou; Thomas, Makris; Petros, Nihoyannopoulos; Dimitris, Tousoulis; Ioannis, Kallikazaros
Recent Patents on Cardiovascular Drug Discovery, Volume 9, Number 2, December 2014, pp. 63-72(10)
The introduction of targeted therapies has revolutionized the management of cancer patients. Agents that target the vascular endothelial growth factor (VEGF), called anti-VEGF, have been administrated for the treatment of various cancer types, inhibiting the carcinogenetic procedure of angiogenesis.
Though their beneficial impact on cancer patients’ outcome, anti-VEGF drugs are accompanied with a broad spectrum of side effects. After searching the literature, we focused on the association between mainly used anti-VEGF anticancer drugs and hypertension (HTN).
Many factors are involved in the emergence of HTN in these patients such as reduced levels of nitric oxide (NO) and/or microvascular rarefaction. The incidence of HTN is high and dependent on which agent is used for treating cancer patients.
In two large meta-analyses, bevacizumab-treated patients had an incidence of developing HTN up to 24% while patients with renal cell carcinoma and gastrointestinal stromal tumors treated with sunitinib had a HTN incidence of approximately 22%. Antihypertensive therapies (i.e angiotensin-converting enzyme inhibitors, b-blockers or diuretics) have been used for the management of anti-VEGF-induced HTN.
Interestingly, the onset of HTN can be considered as a possible biomarker of clinical response to VEGF inhibition (VEGFi) treatment, seeming to be correlated with better overall survival (OS) and prolonged progression free survival in these patients.
Close monitoring of blood pressure (BP) levels, early BP control, proper therapeutic interventions are crucial points in the management of HTN caused by VEGFi. In severe hypertensive cases, discontinuation of anti-VEGF agents or switching to another treatment option might be required. Further research is needed for this exact entity to be elucidated and proper algorithms for HTN handling should be proposed for the optimal benefit of cancer patients.