NEW YORK — Several new and effective anticancer drugs have produced the potentially serious side effect of hypertension in many patients.
Drugs that inhibit the vascular endothelial growth factor signaling pathway (VSP), such as bevacizumab (Ava- stin), sunitinib (Sutent), and sorafenib (Nexavar), have been documented to trigger hypertension in about 10%–40% of patients, Dr. Michael L. Maitland said at a symposium on cardiovascular disease in cancer patients, sponsored by the University of Texas M.D. Anderson Cancer Center, Houston. Some also developed heart failure. Physicians should note that:
▸ Cancer patients who are candidates for VSP inhibitor therapy should undergo a thorough pretreatment risk assessment.
▸ The blood pressure goal for these patients is a maximum of 140/90 mm Hg.
▸ Blood pressure should be measured accurately, early, and often in these patients.
▸ It must be promptly treated.
In addition, if blood pressure spikes, VSP inhibitor therapy should be stopped until the pressure is normalized, said Dr. Maitland, an oncologist and pharmacologist at the University of Chicago. If the anticancer treatment led to a hypertensive emergency, it should not be restarted.
Until guidelines are issued, “the starting point is to treat it like conventional hypertension,” using agents such as ACE inhibitors, angiotensin-receptor blockers, calcium-channel blockers, and β-blockers, he said in an interview.