Vascular and renal effects of anti-angiogenic medicines: French recommendations for practice (Nephrology Society, French Arterial Hypertension Society, National Pedagogical Association for therapeutic teaching and Francophone Federation of digestive cance
Fiche publication
Date publication
janvier 2009
Auteurs
Membres identifiés du Cancéropôle Est :
Pr BOUCHE Olivier
Tous les auteurs :
Halimi JM, Azizi M, Bobrie G, Bouche O, Deray G, des Guetz G, Lecomte T, Levy B, Mourad JJ, Nochy D, Oudard S, Rieu P, Sahali D
Lien Pubmed
Résumé
Angiogenesis inhibitor drugs (bevacizumab, sunitinib, sorafenib...) are now widely used for treatment of cancers, including colorectal, advanced renal cell and hepatocellular carcinomas, breast cancer). Vascular and renal side-effects of the drugs are not well known. Hypertension is one of the most common side effects. Incidence of hypertension may be different among angiogenis inhibitors, and seems dose-depend. Arterial pressure can usually be controlled with anti-hypertensive medications, and treatment with angiogenesis inhibitors can be continued in most cases; however, serious hypertensioninduced side effects were reported included malignant hypertension, stroke and reversible posterior leucoencephalopathy. Renal damage is infrequently reported : usually reversible mild or moderate proteinuria and in some rare cases nephritic syndrome, acute renal dysfunction, proliferative or collapsing glomerulonephritis, interstitial nephritis and thrombotic microangiopathy. Prolongation of the QT interval, congestive heart failure and left ventricular dysfunction have been reported in patients using tinibs. In the present guidelines, we recommend : 1) before the 1st administration of angiogenesis inhibitors : giving acute IV or oral anti-hypertensive medications in a patient with arterial pressure must be avoided; postponing the administration because of hypertension is not recommended; 2) initial work-up should include ambulatory measurement of arterial pressure ( by the general practitioner or by the patient using home blood pressure ( 3 times in the morning and in the evening during 3 consecutive days) with a validated (cf : http://afssaps.sante.fr/) upper arm device. Using 24-hour ambulatory blood pressure measurement is optional; 3) Urine dipstick ( and quantification is positive) and estimated glomerular filtration rate ( using abbreviated MDRD rather than Cockcroft Gault formula) must be performed before treatment and regularly during follow-up; 4) therapeutic management must be done in accordance with national or international guidelines ( in France : http ://www.has-sante.fr/);5) optimal care is best achieved within a network of professionals including general practitioners, oncologists, cardiologists and nephrologists.
Référence
Sang Thromb Vaiss. 2009;21(3):151-66