title: Analysis of early hypertension and clinical outcome with bevacizumab: results from seven phase III studies.
abstract: BACKGROUND
  Hypertension is associated with antivascular endothelial growth factor treatment, but the clinical implications of hypertension are uncertain. To assess the prognostic and predictive value of bevacizumab-related hypertension, a comprehensive analysis of whether hypertension and efficacy outcomes are associated was conducted on seven company-sponsored placebo-controlled phase III studies of bevacizumab.
  
  
  METHODS
  Patient-specific data were available from 6,486 patients with metastatic colorectal, breast, non-small cell lung, pancreatic, and renal cell cancers. Primary hypertension endpoint was a blood pressure (BP) increase of >20 mmHg systolic or >10 mmHg diastolic within the first 60 days of treatment. Additional endpoints included other predefined thresholds of change in BP and severity of hypertension graded using the National Cancer Institute's Common Terminology Criteria for Adverse Events. To analyze the general prognostic importance of an early BP increase, multivariate Cox regression models were used to assess the correlation between BP changes and progression-free (PFS) and overall survival (OS) outcomes in the control groups. To analyze whether early BP increases could predict for benefit from bevacizumab, similar analyses were conducted in the bevacizumab-treated and control groups.
  
  
  RESULTS
  In six of seven studies, early BP increase was neither predictive of clinical benefit from bevacizumab nor prognostic for the course of the disease. For study AVF2107g, early increased BP was associated with longer PFS and OS times in the bevacizumab group but shorter OS time in the control group.
  
  
  CONCLUSIONS
  Early treatment-related BP increases do not predict clinical benefit from bevacizumab based on PFS or OS outcomes. BP increases do not appear to have general prognostic importance for patients with advanced cancer.
authors.affiliation: Department of Medical Oncology, Duke University, Durham, North Carolina 27710-0001, USA. herbert.hurwitz@duke.edu
authors.forename: Herbert I
authors.initials: HI
authors.lastname: Hurwitz
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Douglas
authors.forename: John P
authors.initials: JP
authors.lastname: Middleton
authors.forename: George W
authors.initials: GW
authors.lastname: Sledge
authors.forename: David H
authors.initials: DH
authors.lastname: Johnson
authors.forename: David A
authors.initials: DA
authors.lastname: Reardon
authors.forename: Dafeng
authors.initials: D
authors.lastname: Chen
authors.forename: Oliver
authors.initials: O
authors.lastname: Rosen
mesh_terms: D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects* / Q000627:therapeutic use; D000068258:Bevacizumab; D001943:Breast Neoplasms / Q000188:drug therapy; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy; D002292:Carcinoma, Renal Cell / Q000188:drug therapy; D015179:Colorectal Neoplasms / Q000188:drug therapy; D018572:Disease-Free Survival; D006801:Humans; D006973:Hypertension / Q000139:chemically induced*; D007680:Kidney Neoplasms / Q000188:drug therapy; D008175:Lung Neoplasms / Q000188:drug therapy; D010190:Pancreatic Neoplasms / Q000188:drug therapy; D011379:Prognosis; D012189:Retrospective Studies
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000068258:Bevacizumab