An expert panel provided consensus recommendations for appropriate prevention, surveillance and treatment of hypertension (high blood pressure) in patients treated with vascular endothelial growth factor (VEGF) signaling pathway inhibitors. These recommendations were recently published in the Journal of the National Cancer Institute.[1]

Researchers continue to evaluate novel therapeutic strategies, such as targeted therapies, for the treatment of cancer. Targeted therapies are anticancer drugs that interfere with specific pathways involved in cancer cell growth or survival.

VEGF inhibitors are targeted therapy agents that block the growth of cancer cells by inhibiting several biological pathways that are involved in cellular replication and spread, particularly blood vessel development in tumors. The use of VEGF inhibitors has increased dramatically in recent years.

Avastin® (bevacizumab), Votrient® (pazopanib), Sutent® (sunitinib), and Nexavar® (sorafenib) are examples of VEGF signaling pathway inhibitors. Results from clinical studies have revealed that hypertension is one of the main side effects associated with VEGF signaling pathway inhibitors.

To provide physicians with consensus recommendations on how to optimally manage cardiac toxicities resulting from treatment with VEGF signaling pathway inhibitors, the National Cancer Institute formed a Cardiovascular Toxicities Panel that included experts in hypertension and VEGF signaling pathway inhibitors. The panel advised that appropriate assessment and monitoring for hypertension in patients who are planning to undergo treatment of their cancer with a VEGF signaling pathway inhibitor should include the following:

• Conduct a formal risk assessment of heart health prior to treatment to identify patients at higher risk of cardiovascular side effects,
• Recognize, identify and address preexisting hypertension, including appropriate pretreatment prior to administering VEGF signaling pathway inhibitors,
• Active monitoring and treatment of hypertension need to continue throughout treatment with a VEGF signaling pathway inhibitor, particularly during the first cycle of treatment.
• Although efforts should be made to maintain patients on the full dose and schedule of VEGF signaling pathway inhibitors, dose-reductions or treatment breaks should be considered when hypertension is not being controlled.

The panel also provides physicians with specific hypertension goals and recommendations for management that include consultation with a hypertension specialist when necessary.

Appropriate monitoring and treatment is strongly recommended to prevent cardiovascular complications. Patients receiving treatment with VEGF signaling pathway inhibitors may wish to discuss hypertension monitoring with their healthcare provider.

Reference:

[1] Maitland ML, Bakris GL, Black HR, et al. Initial Assessment, Surveillance, and Management of Blood Pressure in Patients Receiving Vascular Endothelial Growth Factor Signaling Pathway Inhibitors. Journal of the National Cancer Institute. 2010;102:596-604.

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