Management of cardiac toxicity in patients receiving vascular endothelial growth factor signaling pathway inhibitors.
BACKGROUND
Interfering with angiogenesis is an effective, widely used approach to cancer therapy, but antiangiogenic therapies have been associated with important systemic cardiovascular toxicities such as hypertension, left ventricular dysfunction, heart failure, and myocardial ischemia and infarction. As the use of vascular endothelial growth factor signaling pathway (VSP) inhibitors broadens to include older patients and those with existing cardiovascular disease, the adverse effects are likely to be more frequent, and cardiologists will increasingly be enlisted to help oncologists manage patients who develop adverse cardiovascular effects.


METHODS
The Cardiovascular Toxicities Panel of the National Cancer Institute reviewed the published literature and abstracts from major meetings, shared experience gained during clinical development of VSP inhibitors, and contributed extensive clinical experience in evaluating and treating patients with cancer with cardiovascular disease. This report was edited and approved by the National Cancer Institute Investigational Drug Steering Committee. It presents the panel's expert opinion on the current clinical use and future investigation for safer, more expansive use of these drugs.


CONCLUSIONS
The panel recommends that physicians (1) conduct and document a formal risk assessment for existing cardiovascular disease and potential cardiovascular complications before VSP inhibitor treatment recognizing that preexisting hypertension and cardiovascular disease are common in patients with cancer, (2) actively monitor for blood pressure elevations and cardiac toxicity with more frequent assessments during the first treatment cycle, and (3) aggressively manage blood pressure elevations and early symptoms and signs of cardiac toxicity to prevent clinically limiting complications of VSP inhibitor therapy.
Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA. steingar@mskcc.org
Richard M
RM
Steingart
George L
GL
Bakris
Helen X
HX
Chen
Ming-Hui
MH
Chen
Thomas
T
Force
S Percy
SP
Ivy
Carl V
CV
Leier
Glenn
G
Liu
Daniel
D
Lenihan
JoAnn
J
Lindenfeld
Michael L
ML
Maitland
Scot C
SC
Remick
W H Wilson
WH
Tang
D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control; D002319:Cardiovascular System / Q000187:drug effects*; D019468:Disease Management; D004815:Epidermal Growth Factor / Q000037:antagonists & inhibitors*; D014943:Global Health; D006801:Humans; D015994:Incidence; D009369:Neoplasms / Q000188:drug therapy*; D012307:Risk Factors; D015398:Signal Transduction / Q000187:drug effects*
D000970:Antineoplastic Agents; D004815:Epidermal Growth Factor