Retrospective analysis of bevacizumab‐induced hypertension and clinical outcome in patients with colorectal cancer and lung cancer

Abstract

Bevacizumab(Avastin®), a humanized therapeutic monoclonal antibody that targets vascular endothelial growth factor, is widely used in cancer treatment. Patients who are treated with bevacizumab have an increased risk of developing systemic hypertension. However, the relationship between bevacizumab‐induced hypertension and clinical outcome remains unclear. We aimed to evaluate the effect of bevacizumab‐induced hypertension in terms of prognosis in patients with colorectal cancer and non‐small cell lung cancer. The study included 632 patients, 317 patients with non‐small cell lung cancer and 315 patients with colorectal cancer. All patients were treated with bevacizumab in combination with standard chemotherapy protocols, between April 2007 and December 2014. Blood pressure was measured before each treatment cycle. In the patient group with colorectal cancer, treated with bevacizumab, Grade 2–3 hypertension was present in 27.6%. In hypertensive patients with colorectal cancer, median overall survival was 42.6 months, compared with 20.6 months for normotensive patients in this group (P = 0.00071). In the patient group with non‐small cell lung cancer, treated with bevacizumab, Grade 2–3 hypertension was present in 20.5%. In hypertensive patients with non‐small cell lung cancer, median overall survival was 43.0 months, compared with 26.3 months for normotensive patients in this group (P = 0.00451). Patients who developed hypertension during treatment with bevacizumab for colorectal cancer and non‐small cell lung cancer had significantly prolonged overall survival when compared with normotensive patients. Bevacizumab‐induced hypertension may represent a biomarker for clinical benefit in cancer patients treated with bevacizumab.

Predictive factors for the development of proteinuria in cancer patients treated with bevacizumab, ramucirumab, and aflibercept: a single-institution retrospective analysis

“…Previous studies suggested that angiogenesis inhibitor-induced proteinuria is more likely to develop with colorectal cancer 15,19 . However, in the present study, there was no difference in the likelihood of proteinuria among cancer types.…”

Predictors of anti-VEGF drug-induced hypertension using different hypertension criteria: a secondary analysis of the COMPARZ study

“…Although AVEGF-HT might require anti-VEGF dose modification, withdrawal or treatment with antihypertensive drugs, it might also predict favourable survival outcomes in specific types of cancer, including renal cell carcinoma (RCC). 7 – 18 However, other studies have refuted this hypothesis. 19 , 20 Measurement of blood pressure (BP) in these studies was performed at different time points, using different protocols.…”

“…Furthermore, there was a considerable variability in the criteria used for AVEGF-HT, which included ‘hypertension’ listed as diagnosis in medical records, the use of antihypertensive drugs, a predefined absolute BP increase from baseline, and on-treatment BP values above predefined thresholds. 7 – 17 , 19 – 21…”

Molecular targeted treatment of metastatic colorectal cancer: the cardiovascular adverse effects of Bevacizumab and Cetuximab

“…More than 90% of the patients treated will experience a BP elevation, out of which 22–24% develop HTN any grade and 8% grade 3–4 [ 33 , 36 , 37 ]. It may occur at any time after the initiation of the treatment, most often being described after 1 month [ 30 ], or 3 months according to other authors (after 6 cycles) [ 38 ].…”