Vascular Endothelial Growth Factor (VEGF) Inhibitor Cardiotoxicity: What Should We Know?

Abstract

Cancer therapy-induced cardiovascular toxicity is a growing clinical problem with many unanswered questions about the optimal screening, prevention, and management, especially in patients treated with new targeted drugs. Among them, the use of vascular endothelial growth factor inhibitors (VEGFi) has become one of the most promising strategies to successfully approach a wide range of tumors. However, they have been associated with important cardiovascular complications such as systemic hypertension, heart failure, QTc prolongation, and venous and arterial thrombosis. This review addresses a multidisciplinary management of VEGFi-induced cardiotoxicity. Optimal management of antiangiogenic drugs side effects is challenging due to limited evidence-based recommendations. The detection and aggressive treatment of hypertension and other cardiovascular risk factors is essential to minimize treatment interruptions, heart failure, and cardiac arrhythmias. Additionally a close monitoring of signs and symptoms that may raise the suspicion of venous or arterial thromboembolic events is recommended. For that purpose, cardio-oncology approach aims to facilitate cancer therapy and to promote cardio-oncology research. VEFGi use is generally limited by uncontrolled hypertension that may trigger heart failure and cardiac arrhythmias. Therefore, a comprehensive cardio-oncology approach is needed to establish effective preventive and monitoring protocols.