Hypertension and targeted therapy Part 2: Small molecule inhibitors of VEGF

Hypertension is emerging as one of the most common side effects of treatment with angiogenesis inhibitors. This was first demonstrated in studies using bevacizumab, but has subsequently been identified when using small molecule tyrosine kinase inhibitors of VEGF. This article reviews the data relating to hypertension associated with the use of small molecule inhibitors as well as recommendations for monitoring and managing hypertension. It is important that blood pressure is monitored during and after treatment, and that medical therapy is instigated appropriately. With increasing experience in their use, clinicians can rapidly gain experience in treating emergent hypertension caused by these drugs. Proactive introduction or even prophylactic use of one or more antihypertensive drugs can allow maintenance of therapy despite onset of hypertension. Studies currently in progress are exploring optimal strategies for control of blood pressure related to VEGF-targeting therapies.