Cancer drugs that inhibit tumor blood vessel growth, called angiogenesis inhibitors, can be used effectively while minimizing elevated blood pressure (hypertensive) side effects if patients’ blood pressure is closely monitored and controlled, a clinical panel has determined. The Cardiovascular Toxicities panel, convened by the Angiogenesis Task Force of the National Cancer Institute Investigational Drug Steering Committee drafted new recommendations for oncologists using antiangiogenic agents for the treatment of cancer. Hypertension, associated with the targeting of an angiogenic protein called VEGF (vascular endothelial growth factor) is the most common side effect of this class of cancer drugs.
Assessing and treating any pre-existing hypertension using standard medications before starting angiogenesis inhibitors, and then closely monitoring patients’ blood pressure in the days after beginning treatment can help physicians control this side effect, the panel concluded in their report, published in the Journal of the National Cancer Institute (2010;102(9):596-604). “This paper should impact practice today,” said Michael Maitland, M.D., Ph.D., assistant professor of medicine at the University of Chicago Medical Center and lead author on the commentary. “It should make things safer on average for patients, and will give physicians important guidance.”
The panel recommended that patients should be thoroughly screened before treatment with angiogenesis inhibitors, and a risk assessment performed, similar to the cardiovascular assessment patients receive before major surgery, Dr. Maitland said. Before treatment begins, blood pressure in high-risk patients should be reduced and maintained at less than 140/90 mmHg, or even lower in patients with diabetes or chronic kidney disease.
A variety of routine antihypertensive drug classes can be used to lower a patient’s blood pressure before or during treatment with antiangiogenic agents, but physicians should, as always, be alert and monitor for any potential adverse interactions between the two drugs.  Such drug interactions are not frequent. Oncologists faced with complex cases of blood pressure management should consult with a cardiologist or an internist experienced in managing hypertension, the panel advised.
Improved monitoring and treatment of hypertension may improve access to antiangiogenic treatments among cancer patients considered to be at high risk for the side effect due to a history of cardiovascular disease or a predisposition.