title: VEGF inhibition, hypertension, and renal toxicity.
abstract: The use of anti-angiogenic agents as part of the therapeutic armamentarium for advanced stage solid tumors has become the standard of care in several instances, particularly for renal cell carcinoma, non-small cell lung carcinoma, colorectal carcinoma, and gastrointestinal stromal tumors. These agents primarily target vascular endothelial growth factor (VEGF) and/or its receptors, and include bevacizumab, a humanized monoclonal antibody against VEGF, as well as tyrosine kinase inhibitors that target several receptor tyrosine kinases (RTK), including VEGF receptors. These therapies, as a general class of anti-angiogenic medications, have been shown to have common adverse vascular effects attributable directly or indirectly to their anti-VEGF effects, including hypertension, renal vascular injury, often manifested by proteinuria and thrombotic microangiopathy, and congestive heart failure. Knowledge of these common side effects and their underlying mechanisms may allow for more accurate and prompt diagnoses, timely clinical interventions, and the development of rational and standard treatments. These measures may minimize patient morbidity and mortality, not only by the treatment of side effects, but also by minimizing the disruption of treatment of the underlying malignancy, as well as improving patient quality of life.
authors.affiliation: Department of Internal Medicine, Division of Hematology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA. Hayman.suzanne@mayo.edu
authors.forename: Suzanne R
authors.initials: SR
authors.lastname: Hayman
authors.forename: Nelson
authors.initials: N
authors.lastname: Leung
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Grande
authors.forename: Vesna D
authors.initials: VD
authors.lastname: Garovic
mesh_terms: D020533:Angiogenesis Inhibitors / Q000009:adverse effects*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D006801:Humans; D006973:Hypertension / Q000139:chemically induced*; D047428:Protein Kinase Inhibitors / Q000009:adverse effects*; D011507:Proteinuria / Q000139:chemically induced; D051437:Renal Insufficiency / Q000139:chemically induced*; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors*
chemical_list: D020533:Angiogenesis Inhibitors; D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors; D042461:Vascular Endothelial Growth Factor A