Abstract
Inhibitors of the vascular endothelial growth factor (vegf-is) signalling pathway have fundamentally changed the treatment of metastatic renal cell carcinoma (mrcc). Hypertension is one of the most common side effects of vegf-is and has been reported with almost every vegf-i used for treatment to date. The exact mechanism of vegf-i-induced hypertension appears complex and multifactorial, and it remains to be fully explained. No randomized clinical trials are available to guide the management of hypertension during vegf-i treatment in mrcc patients. The guiding principles suggested here summarize the consensus of opinions on the diagnosis and management of vegf-i-induced hypertension during treatment of mrcc obtained from an expert working group composed of 4 Canadian medical oncologists and 5 Canadian hypertension specialists. The Canadian Hypertension Education Program guidelines, available literature, and expert opinion were used to develop the guiding principles.
Highlights
Inhibitors of the vascular endothelial growth factor signalling pathway are increasingly used in the treatment of a variety of cancers
These vegf-is have fundamentally changed the treatment of metastatic renal cell carcinoma
Today, according to the Memorial Sloan–Kettering Cancer Center classification, sunitinib is considered the reference standard for the first-line treatment of good- and intermediate-prognosis mrcc patients, and sorafenib can be considered for patients with failure of first-line cytokine therapy[1]
Summary
Inhibitors of the vascular endothelial growth factor (vegf-is) signalling pathway are increasingly used in the treatment of a variety of cancers. Today, according to the Memorial Sloan–Kettering Cancer Center classification, sunitinib is considered the reference standard for the first-line treatment of good- and intermediate-prognosis mrcc patients, and sorafenib can be considered for patients with failure of first-line cytokine therapy[1] These very effective agents have a novel sideeffect profile. The severity of hypertension was defined, in most cases, using the definition set out by the Common Terminology Criteria for Adverse Effects, version 3 (therapy requiring more than 1 drug or more intensive treatment than previously)[21] This classification of hypertension is different from the classifications used by hypertension societies, and it may overestimate the percentage of patients with a significant increase in bp. As the long-term survival of cancer patients on anti-angiogenic therapy increases, the foregoing complications may become an important issue in their management
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