Abstract P005: Treatment And Clinical Implications Of Vascular Endothelial Growth Factor (VEGF) Inhibitor-induced Blood Pressure Rise: A Clinical Cohort Study

Abstract

Vascular endothelial growth factor inhibitors (VEGFI) are highly effective anti-cancer agents, but frequently induce a rise in blood pressure (BP). The optimal treatment of this BP rise is currently unknown, and risk factors for this rise and its association with survival remain unclear. To this end, baseline characteristics and BP readings were collected from electronic medical records from oncology patients who received oral VEGFI treatment (sorafenib, sunitinib, pazopanib, regorafenib, lenvatinib or cabozantinib) in the period of 2008 until 2020. Risk factors for a clinically relevant BP rise, defined as an increase of ≥20mmHg in systolic BP (SBP) and/or ≥10mmHg in diastolic BP (DBP), were investigated via logistic regression, and their association with survival via Cox regression analysis. In total, 343 patients were included of whom 162 (47%) developed a clinically relevant rise in BP ≥ 7 days after VEGFI treatment initiation. Both calcium channel blockers (CCB) and renin-angiotensin system inhibitors (RASI) effectively reduced SBP (-24.1mmHg and -18,2mmHg, respectively) and DBP (-12.0mmHg and -11mmHg, respectively) when started during VEGFI therapy. Pazopanib therapy (OR: 2.67, 95% CI 1.33-5.34, P =0.006, compared to sorafenib) and eGFR < 60ml/min/1.73m 2 (OR: 1.77, 95% CI 1.00-3.11, P =0.049) were risk factors for a BP rise, whereas a baseline BP of >140/90mmHg was associated with a lower risk (OR: 0.39, 95% CI 0.25-0.62, P <0.001). Only for renal cell carcinoma (RCC) patients, BP rise was associated with substantially improved overall survival (OS) compared to patients without BP rise (median OS 45.4 versus 20.3 months, respectively, P =0.003). No significant difference in OS between patients with and without new antihypertensives during VEGFI therapy was found (median OS 21.9 vs. 18.5 months, respectively, P = 0.143). In conclusion, the VEGFI-induced BP rise is determined by the type of VEGFI, baseline BP, and baseline eGFR. Both CCB and RASI can be used as effective antihypertensive treatment without impairing OS. Our study identified unique risk factors for a VEGFI-induced BP rise and demonstrated that this rise is an indication of treatment efficacy in RCC patients.