Initial assessment, surveillance, and management of blood pressure in patients receiving vascular endothelial growth factor signaling pathway inhibitors Journal Article
| Authors: | Maitland, M. L.; Bakris, G. L.; Black, H. R.; Chen, H. X.; Durand, J. B.; Elliott, W. J.; Ivy, S. P.; Leier, C. V.; Lindenfeld, J.; Liu, G.; Remick, S. C.; Steingart, R.; Tang, W. H. W. |
| Article Title: | Initial assessment, surveillance, and management of blood pressure in patients receiving vascular endothelial growth factor signaling pathway inhibitors |
| Abstract: | Hypertension is a mechanism-based toxic effect of drugs that inhibit the vascular endothelial growth factor signaling pathway (VSP). Substantial evidence exists for managing hypertension as a chronic condition, but there are few prospectively collected data on managing acute hypertension caused by VSP inhibitors. The Investigational Drug Steering Committee of the National Cancer Institute convened an interdisciplinary cardiovascular toxicities expert panel to evaluate this problem, to make recommendations to the Cancer Therapy Evaluation Program on further study, and to structure an approach for safe management by treating physicians. The panel reviewed: the published literature on blood pressure (BP), hypertension, and specific VSP inhibitors; abstracts from major meetings; shared experience with the development of VSP inhibitors; and established principles of hypertension care. The panel generated a consensus report including the recommendations on clinical concerns summarized here. To support the greatest possible number of patients to receive VSP inhibitors safely and effectively, the panel had four recommendations: 1) conduct and document a formal risk assessment for potential cardiovascular complications, 2) recognize that preexisting hypertension will be common in cancer patients and should be identified and addressed before initiation of VSP inhibitor therapy, 3) actively monitor BP throughout treatment with more frequent assessments during the first cycle of treatment, and 4) manage BP with a goal of less than 140/90 mmHg for most patients (and to lower, prespecified goals in patients with specific preexisting cardiovascular risk factors). Proper agent selection, dosing, and scheduling of follow-up should enable maintaining VSP inhibition while avoiding the complications associated with excessive or prolonged elevation in BP. © The Author 2010. Published by Oxford University Press. All rights reserved. |
| Keywords: | signal transduction; epidermal growth factor; adult; aged; middle aged; unclassified drug; sorafenib; bevacizumab; sunitinib; drug efficacy; drug safety; hypertension; liver cell carcinoma; nonhuman; antineoplastic agents; note; alpha interferon; cancer patient; follow up; colorectal cancer; gastrointestinal stromal tumor; consensus; nephrotoxicity; breast cancer; bleeding; clinical assessment; risk factors; lung cancer; vasculotropin inhibitor; kidney carcinoma; risk assessment; cardiovascular disease; cardiovascular risk; cardiotoxicity; thrombosis; glioblastoma; aflibercept; cediranib; pazopanib; vandetanib; medical literature; blood pressure; kidney cancer; axitinib; motesanib; population surveillance; beta adrenergic receptor blocking agent; calcium channel blocking agent; dipeptidyl carboxypeptidase inhibitor; thiazide diuretic agent; angiotensin receptor antagonist; disease surveillance; amlodipine; dihydropyridine; felodipine; vegf trp; votrient; blood pressure monitoring; antihypertensive agents; blood pressure determination; blood pressure monitoring, ambulatory |
| Journal Title: | JNCI: Journal of the National Cancer Institute |
| Volume: | 102 |
| Issue: | 9 |
| ISSN: | 0027-8874 |
| Publisher: | Oxford University Press |
| Date Published: | 2010-05-05 |
| Start Page: | 596 |
| End Page: | 604 |
| Language: | English |
| DOI: | 10.1093/jnci/djq091 |
| PUBMED: | 20351338 |
| PROVIDER: | scopus |
| PMCID: | PMC2864290 |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 7" - "Export Date: 20 April 2011" - "CODEN: JNCIA" - "Source: Scopus" |
