Mechanism: Production of vasodilatory compounds (such as nitric oxide and prostacyclin) may be inhibited resulting in increased peripheral vascular resistance.
Examples of VEGF signal inhibitors:
(1) bevacizumab
(2) cediranib
(3) sorafenib
(4) sunitinib
(5) vatalanib
(6) axitinib
Langenberg et al found that monitoring a patient before, during and after therapy with cediranib allowed early interventions that prevented serious hypertensive complications. A calcium channel blocking agent (or selective beta-blocking agent) were first-line treatments for mild to moderate hypertension during VEGF inhibitor therapy.
Recommendations:
(1) Screen patients for hypertension prior to starting therapy.
(2) A patient should be started on a prophylactic antihypertensive regimen prior to (if hypertensive) or concurrent with (if normotensive) starting the VEGF inhibitor therapy.
(3) A patient should have blood pressure monitored frequently during therapy.
If hypertension develops during therapy then:
(1) Discontinue the VEGF inhibitor.
(2) Control the blood pressure with a protocol determined by the severity of the hypertension.
(3) If the blood pressure is controlled and if there are no contraindications then the VEGF may be reintroduced, typically at a lower dose.
Reasons to permanently discontinue a VEGF inhibitor:
(1) Severe hypertension that recurs after appropriate management and despite antihypertensive therapy.
(2) Mild to moderate hypertension that continues to increase or that is uncontrolled despite maximal management and antihypertensive therapy.
