Expert Suggests Having a Risk Assessment of VEGF Inhibitor-Related Cardiovascular Toxicity

It may be worth considering the pathophysiology and vascular complications of chemotherapy, especially among patients who are already hypertensive.

Traditional vascular endothelial growth factor (VEGF) medications, and specifically VEGF inhibitors (VEGFi), are an effective anti-cancer therapeutic agent. However, these medications can be bad for blood pressure and cardiovascular health, according to Gavin Oudit, MD, PhD, FRCPC, professor, Division of Cardiology, Department of Clinician Scientist, University of Alberta, who presented these findings during a session at the American Society for Nephrology Kidney Week conference.

“If it’s good for cancer, it’s probably bad for the cardiovascular system,” Oudit said.

Hypertension is a leading cause of chronic kidney disease (CKD), and kidneys are the most important long-term determinates of blood pressure control.

“See, you heard it from a cardiologist. We acknowledge how critical the kidneys are,” Oudit said.

Hypertension can lead to other severe outcomes, including cardiovascular disease and heart failure. Data from the International CardioOncology Society found that very high blood pressure was associated with acute hypertension-mediated organ damage to the heart, brain, and kidneys. Consequently, data show that reducing high blood pressure can lower the risk of organ damage, which Oudit noted during the session.

Use of VEGFi may cause hypertension by disrupting normal endothelial function, decreasing nitric oxide, or creating vascular remodeling. Oudit suggests that health care providers consider the risk of cardiovascular (CV) toxicity and hypertension when managing patients during and after cancer treatment. He also recommends that practitioners consider the global risk of the patient when choosing a treatment pathway.

This method considers basic patient histories, including physical health, heart health, current medications, and blood pressure management. It considers all comorbidities, adjusts medications as needed, and continues to monitor for hypertension after the cancer is gone and the medications are stopped.

He prefers choosing treatments based on their drug interactions. This may reduce the time it takes to treat cancer because all of a patient’s risks are accounted for, and adverse effects (AEs), such as hypertension, are not prolonging treatment. Fortunately, there are hypertension drugs that health care professionals can use to reduce the hypertensive effects of VEGFi.

Generally, cancer chemotherapy can have many vascular complications that lead to severe AEs.

“One of the key issues with chemotherapy…is that it can be rapid,” Oudit said. “You can go from a relatively healthy state to a very sick state very quickly.”

Current classes of anti-cancer drugs include Bruton’s tyrosine kinase inhibitors, platinum-based compounds, protease inhibitors, and VEGFi, with the main drug being sunitinib. For patients who are qualified to use chemotherapy as a therapeutic option, Oudit suggests avoiding diuretics, which can lead to dehydration.

He also suggests that patients avoid non-steroidal anti-inflammatory drugs, which are often given for pain management.

“The key take-home message here is that the level of evidence guiding the recommendations are all…expert opinion,” Oudit said. “After cancer therapy, treatment does not end…[and] not everyone is going to respond the same way.”

Reference

Oudit, Gavin. New-Onset Hypertension in Patients with Cancer Secondary to Cancer Therapies. ASN Kidney Week. November 3, 2022. https://www.asnonline.org/education/kidneyweek/2022/program-session-details.aspx?sessId=420008