Management of hypertension in angiogenesis inhibitor-treated patients

Izzedine, Hassane; Éderhy, Stéphane; Goldwasser, François; Soria, Jean‐Charles; Milano, Gérard; Cohen, Ariel; Khayat, David; Spano, Jean‐Philippe

doi:10.1093/annonc/mdn713

Cited by 312 publications

(234 citation statements)

References 52 publications

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“…The mechanism(s) by which different chemotherapy agents induce hypertension is not fully understood. Potential mechanisms include vascular rarefaction (decrease in microvessel density), decreased sex hormones leading to impaired vasodilator and potentiated vasoconstrictor effects, and endothelial dysfunction causing an interference with nitric oxide (NO) signaling and thereby an increase in oxidative stress (Townsend et al, 2006;Jain et al, 2007;Izzedine et al, 2009).…”

Section: Discussionmentioning

confidence: 99%

“…As hypertension is a risk factor for coronary heart disease, stroke, heart failure, and end-stage renal disease (Izzedine et al, 2009), an improved understanding of hypertension prior to starting chemotherapy, new-onset hypertension during and after chemotherapy, and factors influencing hypertension among cancer patients is paramount. Prior studies have focused on the prevalence of hypertension in cancer patients rather than incidence (Havlik et al, 1994;Satariano et al, 1994;Yancik et al, 2001;Ko et al, 2002;Piccirillo et al, 2004;Tammemagi et al, 2005;Smith et al, 2008), but the incidence of newonset hypertension is an important clinical outcome that requires investigation.…”

Section: Discussionmentioning

confidence: 99%

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Clinical Safety of Chemotherapy for Elderly Cancer Patients Complicated with Hypertension

Qian

Xu²,

Wang³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Objective: To access the safety of chemotherapy for elderly cancer patients complicated with hypertension. Methods: Elderly cancer patients who were complicated with hypertension and treated by chemotherapy were recruited. All patients were treated by chemotherapy after an intervention on hypertension by psychotherapy, exercise guidance, salt regulation and nutrition support, therapy on hypertension, as well as prevention on hypertension associated complications. Results: In 68 eligible patients, two suspended chemotherapy because of adverse reactions and 4 because of disease progression. The remaining 62 patients completed chemotherapy smoothly based on good hypertension control. Conclusion: With effective control of blood pressure, chemotherapy for elderly cancer patients complicated with hypertension is generally safe.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical Safety of Chemotherapy for Elderly Cancer Patients Complicated with Hypertension

Qian

Xu²,

Wang³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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“…En un estudio retrospectivo de más de 25.000 pacientes con varios tipos de cáncer, que registraron una presión arterial (PA) normal al momento del diagnóstico (independientemente de sus anteceden-tes), casi un tercio desarrolló algún grado de HTA durante el tratamiento oncológico (32,16 casos por 100 personas/año) (7) . La mayoría desarrolló hipertensión moderada, pero 12,36 por 100 personas/año tuvieron cifras de PA sistólica entre 160 y 180 mmHg y 2,79 por 100 personas/año tuvieron cifras de PA sistólica mayores de 180.…”

Section: Convergencia Epidemiológicaunclassified

“…Además de la disminución del óxido nítri-co se han propuesto otros mecanismos como incremento de endotelina 1, rarefacción microvascular, activación del sistema renina angiotensina, estrés oxidativo, daño glomerular renal y aumento de la rigidez arterial de los grandes vasos. Es frecuente que, junto con la HTA, las drogas IA induzcan algún grado de proteinuria, aunque es raro que por sí solas afecten sostenidamente la función renal (16) .…”

Section: Inhibidores De Tirosina Quinasaunclassified

Hipertensión arterial y tratamiento del cáncer

Paganini

2018

Rev.Urug.Cardiol.

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ResumenLa hipertensión arterial (HTA) tiene alta prevalencia y es la comorbilidad más frecuente al momento del diagnóstico de cáncer. La nueva aparición o el agravamiento de la HTA durante el tratamiento oncológico es también común, sobre todo durante los períodos de quimioterapia. Si bien varias drogas utilizadas en quimioterapia tienen potencial pro hipertensivo, los fármacos inhibidores de la angiogénesis tienen un efecto de clase sobre la presión arterial (PA) y son los que plantean mayores problemas al médico. Los tratamientos de sostén también pueden incrementar la PA, sobre todo la eritropoyetina, los antiinflamatorios no esteroideos y los corticoesteroides. No existe una guía específica basada en evidencia para el manejo de la HTA durante el tratamiento del cáncer, por tanto se revisan las recomendaciones de expertos para enfrentar este problema frecuente. Palabras clave: Hypertension and cancer treatment SummaryHypertension is highly prevalent and the most frequent comorbidity at the initial diagnosis of cancer. New onset or worsening hypertension is also common during cancer treatment, in particular during chemotherapy periods. Several drugs used in chemotherapy could have an hypertensive effect, for instance angiogenesis inhibitors have a class effect on blood pressure and frequently clinicians confront this problem. Adjuvant drugs in cancer treatment could also increase blood pressure, especially erythropoietin, non-steroidal anti-inflammatory drugs and corticosteroids. There are not specific evidence based guidelines for the management of hypertension during cancer treatment, for that reason we review expert suggestions to deal with this frequent issue. Key words: HYPERTENSION NEOPLASMS CHEMOTHERAPY ANGIOGENESIS INHIBITORS I. Convergencia epidemiológicaLa prevalencia promedio de hipertensión arterial (HTA) en la población adulta (mayor de 25 años) de las Américas ha sido estimada en 35%, según un reporte de la Organización Mundial de la Salud del año 2013 (1) . Esta prevalencia es creciente con la edad, por lo que se encuentra presente en la mayoría de las personas que tienen más de 60 años. La prevalencia de cáncer también aumenta con la edad y comparte varios factores de riesgo con la enfermedad cardiovascular (tabaco, dieta inadecuada, obesidad, sedentarismo). La HTA constituye la comorbilidad más frecuente entre los pacientes con diagnóstico inicial de cán-cer, con una prevalencia que se ha estimado próxima a 40% o mayor en esa población (2)(3)(4) . Asimismo, estudios epidemiológicos recientes ajustados por edad y otras variables han encontrado un riesgo aumentado de cáncer y de mortalidad por esta causa entre los pacientes hipertensos (5,6) .La aparición de nuevos casos de HTA o el agravamiento de la misma en quienes ya la padecen es muy común durante el tratamiento del cáncer. En un estudio retrospectivo de más de 25.000 pacientes con varios tipos de cáncer, que registraron una presión arterial (PA) normal al momento del diagnóstico (independientemente de sus anteceden- 43MP Medicina Personali...

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“…In individual phase III trials, incidences of grade 3/4 hypertension up to 17 % were reported with bevacizumab [7,11,17]. As early initiation of antihypertensive therapy may help to maintain treatment schedules [18,19] and reduce complications [20,21], identification of patients at high risk for bevacizumab-induced hypertension could be clinically valuable. Anti-angiogenic strategies are used increasingly for prolonged periods and/or in multiple treatment lines [4], and consequently the clinical importance of managing complications resulting from chronic blood pressure elevation might gain increased prominence.…”

Section: Introductionmentioning

confidence: 99%

Genetic markers of bevacizumab-induced hypertension

et al. 2014

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Purpose There are currently no validated biomarkers predicting bevacizumab treatment outcome or toxicity. We combined biomarker data from six phase III trials of bevacizumab to assess whether genetic variation in vascular endothelial growth factor-A (VEGF-A) pathway or hypertension-related genes are associated with bevacizumab-induced hypertension. Experimental design Germline DNA was available from 1,631 patients receiving bevacizumab-containing therapy for advanced solid tumors. Overall, 194 white patients had grade 1-4 bevacizumab-induced hypertension. In total, 236 single nucleotide polymorphisms (SNPs) located in VEGF-A, VEGF-A receptors (FLT1 and KDR), and other genes were selected using a SNP tagging approach and genotyped. A logistic regression on individual patient data was performed after adjustment for cancer type and five other covariates. Results Ten SNPs were associated with bevacizumabinduced hypertension (P B 0.05), but none surpassed the threshold adjusted for multiple testing (P \ 0.0002). The most significant VEGF-A pathway SNP was rs1680695 in EGLN3 [allelic odds ratio (OR) 1.50 [95 % confidence interval (Cl) 1.09-2.07], P = 0.012]. Two additional SNPs, rs4444903 in EGF and rs2305949 in KDR, were associated with hypertension (allelic OR 1.57 [95 % CI 1.17-2.11], P = 0.0025; allelic OR 0.62 [95 % CI 0.42-0.93], P = 0.020, respectively) and closely linked to nearby functional variants. Consistent with previous reports, rs11064560 in WNK1 was also associated with bevacizumab-induced hypertension (OR 1.41 [95 % CI 1.04-1.92], P = 0.028). Conclusions The genes described in this large genetic analysis using pooled datasets warrant further functional 123 Angiogenesis (2014) 17:685-694 DOI 10.1007 investigation regarding their role in mediating bevacizumab-induced hypertension.

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Management of hypertension in angiogenesis inhibitor-treated patients

Cited by 312 publications

References 52 publications

Clinical Safety of Chemotherapy for Elderly Cancer Patients Complicated with Hypertension

Clinical Safety of Chemotherapy for Elderly Cancer Patients Complicated with Hypertension

Hipertensión arterial y tratamiento del cáncer

Genetic markers of bevacizumab-induced hypertension

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