New recommendations push for improved monitoring and control to limit cancer drug side effects

Doctors who monitor and help control a patient's blood pressure can minimize the side effects of novel cancer drugs, according to a paper published in the Journal of the National Cancer Institute (2010 May 5;102(9):596-604).

The conclusion, issued by a panel of clinical experts, supports a draft of new recommendations for physicians prescribing angiogenesis inhibitors for the treatment of cancer. The panel explained that treating a patient's hypertension before starting the inhibitors and closely monitoring blood pressure in the days after treatment begins can help physicians control this side effect. “Those precautions may allow patients at higher risk for cardiovascular disease to benefit from these novel cancer treatments,” the authors said.

Among the recommendations made, the panel suggested that a patient should be thoroughly screened before treatment with angiogenesis inhibitors. In addition, a risk assessment should be performed, similar to the cardiovascular assessment given to patients before major surgery. Lastly, before treatment begins, blood pressure in high-risk patients should be reduced and maintained at less than 140/90 mm Hg, or even lower in patients with diabetes or chronic kidney disease.

According to the press release announcing the recommendations, a variety of antihypertensive drug classes can be used to lower a patient's blood pressure before or during treatment with angiogenesis inhibitors, but physicians should be aware of potential adverse interactions between the two drugs. “Oncologists faced with complex cases of blood pressure management should consult colleagues more experienced in cardiology and hypertension,” the panel advised. 

The panel explained that an improvement in monitoring and treating hypertension during angiogenesis inhibitor treatment may allow patients at high risk for side effects to take advantage of the treatment.

“This drug class has great potential for altering the natural history of many cancers. With this guidance, all physicians involved in the care of a cancer patient will be aware of monitoring blood pressure and signs of kidney injury and will know what to do if such problems arise,” said George Bakris, MD, director of the Hypertensive Disease Unit at the medical center and an author on the commentary. “If carefully managed, I think these drugs are a huge move forward in our armory against cancer.”

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