Abstract 14762: Prospective Study Evaluating Management of Hypertension Induced by Anti-VEGF Therapy in Patient With Active Cancer: Preliminary Report From the VEGFHTN Trial

Abstract

Introduction: A nti-neoplastic agents that target vascular endothelial growth factor (VEGF) are known to have cardiovascular toxicities, principally hypertension, with a reported incidence of 21-40% in first-time users. Anti-VEGF induced hypertension can be challenging to control, and significant enough to lead to a dose reduction or discontinuation of the VEGF-targeted therapy, preventing patients from completing their cancer therapy. Methods: A single center prospective cohort of patients with cancer starting anti-VEGF therapy was compared to a retrospective control cohort that was 1:1 matched on gender, race, ethnicity, cancer type, and anti-VEGF therapy. For the prospective cohort, antihypertensive medications were started per an anti-VEGF hypertension algorithm. Elevated blood pressure was defined as consecutive blood pressure readings above 140/90 mmHg and control of blood pressure defined as consecutive readings <140/90 mmHg. Time to development of elevated blood pressure and blood pressure control, number of anti-hypertensive medications needed to control blood pressure were recorded. Results: The prospective cohort consisted of 31 patients which were 1:1 matched to 31 controls who received antihypertensives per standard of care. There were 50% female patients with mean age 61.0 ± 11.9 years. The most common anti-VEGF therapies received included lenvatinib (39%) and bevacizumab (33%) and the most common cancers being treated were kidney (43%) and liver (39%). In the prospective cohort , 24 (77%) developed hypertension greater than 140/90 mmHg compared to 18 (42%) in the control cohort (p=0.174). Of those who developed hypertension the time to control of blood pressure (<140/90mmHg) was improved in the prospective algorithmic approach to anti-VEGF hypertension compared to control (30.5 ± 35.6 days vs 104.9 ± 121.2 days respectively, p=0.007). More anti-hypertensive medications were used in the prospective cohort compared to the matched control (2.6 ± 1.1 vs 1.3 ± 1.0 respectively, p<0.001). Conclusion: A significant proportion of patients receiving VEGF-targeted therapy will develop hypertension. An algorithmic approach to anti-VEGF hypertension leads to earlier blood pressure control.