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.
authors.affiliation: Department of Medicine, University of Chicago Medical Center, 5841Chicago, IL 60637, USA. mmaitlan@medicine.bsd.uchicago.edu
authors.forename: Michael L
authors.initials: ML
authors.lastname: Maitland
authors.forename: George L
authors.initials: GL
authors.lastname: Bakris
authors.forename: Henry R
authors.initials: HR
authors.lastname: Black
authors.forename: Helen X
authors.initials: HX
authors.lastname: Chen
authors.forename: Jean-Bernard
authors.initials: JB
authors.lastname: Durand
authors.forename: William J
authors.initials: WJ
authors.lastname: Elliott
authors.forename: S Percy
authors.initials: SP
authors.lastname: Ivy
authors.forename: Carl V
authors.initials: CV
authors.lastname: Leier
authors.forename: Joann
authors.initials: J
authors.lastname: Lindenfeld
authors.forename: Glenn
authors.initials: G
authors.lastname: Liu
authors.forename: Scot C
authors.initials: SC
authors.lastname: Remick
authors.forename: Richard
authors.initials: R
authors.lastname: Steingart
authors.forename: W H Wilson
authors.initials: WH
authors.lastname: Tang
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects*; D001795:Blood Pressure Determination; D018660:Blood Pressure Monitoring, Ambulatory; D004815:Epidermal Growth Factor / Q000037:antagonists & inhibitors* / Q000378:metabolism; D005260:Female; D006801:Humans; D006973:Hypertension / Q000139:chemically induced* / Q000503:physiopathology / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012307:Risk Factors; D015398:Signal Transduction / Q000187:drug effects*
chemical_list: D000959:Antihypertensive Agents; D000970:Antineoplastic Agents; D004815:Epidermal Growth Factor