Hypertension and targeted therapy Part 1: Bevacizumab

Angiogenesis is essential for tumor growth and metastasis and is an important target for new antineoplastic agents. Vascular endothelial growth factor ( VEGF) is one of the best characterized of the proangiogenic growth factors that regulate angiogenesis and is a logical target for cancer therapy. Bevacizumab, a humanized monoclonal antibody directed at VEGF, has shown promising results in a range of solid tumors. To maximize the potential of this agent further research is needed to clarify a number of important issues including dose, schedule, possible combinations, and management of toxicities. Hypertension is the most commonly identified toxicity and has been reported in all studies involving bevacizumab. It is important that blood pressure is monitored before, during and after treatment, and that medical therapy is instigated appropriately. Most patients with bevacizumab-associated hypertension require drug treatment and standard oral antihypertensives control virtually all episodes. Hypertensive crises are rare but require discontinuation of treatment. Bevacizumab represents a successful example of targeted therapy for cancer treatment. As these new therapies are introduced into current practice it is important that oncologists not only recognize a new set of toxicities, such as hypertension, but also learn how to recognize and manage them effectively.