Dr Kraft on VEGF Inhibitor–Induced Hypertension in RCC

Shawna Kraft, PharmD, BCOP, clinical oncology specialist, ambulatory oncology for genitourinary (GU) cancer, breast cancer and melanoma, clinical associate professor, University of Michigan College of Pharmacy, University of Michigan Health, discusses the incidence and mitigation of VEGF inhibitor–induced hypertension in patients with renal cell carcinoma (RCC).

Hypertension is a common adverse effect (AE) associated with the use of VEGF inhibitors for patients with RCC and tends to occur early in the treatment course. As such, it is vital to minimize the risk of worsening hypertension in patients already experiencing this condition.

Recent data have suggested that women are at higher risk of experiencing higher blood pressure when given a VEGF inhibitor, Kraft says. However, there is currently overwhelming evidence definitively identifying risk factors for the development of hypertension in patients with RCC, she notes.

The management of VEGF inhibitor–induced hypertension involves strategies typically utilized when normally controlling blood pressure, Kraft continues. According to the American College of Cardiology and American Heart Association, hypertension is defined as a blood pressure above 140/90 mm Hg and the goal is to maintain a patient’s blood pressure at less than 130/80 mm Hg.

Prior to VEGF treatment initiation, a patient's blood pressure must be controlled, Kraft emphasizes. Blood pressure should be closely monitored every day for the first 6 weeks of VEGF treatment, and standard anti-hypertensives should be administered if blood pressure rises over 150/100 mm Hg.

When selecting the optimal management strategy, diuretics, Angiotensin-converting enzyme (ACE) inhibitors, Angiotensin 2 receptor blockers (ARBs), or calcium channel blockers should be primarily considered, Kraft says. Although other treatment options exist, current literature demonstrates that these 4 drug classes are the most effective at mitigating VEGF-induced hypertension, Kraft explains. Notably, patients with compromised kidney function should be cautious about receiving a diuretic, and may want to consider an alternative treatment, Kraft adds.