Nitric oxide and adverse events of vascular endothelial growth factor inhibitors

Background: Angiogenesis inhibitors targeting the vascular endothelial growth factor (VEGF) signalling pathways have demonstrated therapeutic efficacy in a wide variety of malignancies. With their increased use, adverse events, some common and certain rare but characteristic complications, are being recognized. The exact mechanisms for the development of at least some of these side effects are not entirely clear. Scope: Review of the current literature with respect to mechanisms for the development of side effects to VEGF blocking agents was reviewed. Findings: Nitric oxide is a key molecule in the downstream signalling pathway for VEGF. Blockade of nitric oxide by the VEGF antagonists results in several class-specific adverse events. Conclusion: Nitric oxide can be considered as an important factor in the development of most of the common and rare adverse events related to VEGF antagonists.