abstract: Treatment of bevacizumab-induced hypertension by amlodipine. Invest New Drugs. 2012

abstract: Treatment of bevacizumab-induced hypertension by Amlodipine

Also reference:
NORVASC® (amlodipine besylate) Tablets for Oral Administration

http://www.rxlist.com/norvasc-drug.htm

Abstract/full acess: Hypertension and hand-foot skin reactions related to VEGFR2 genotype and improved clinical outcome following bevacizumab and sorafenib

Background: Hypertension (HT) and hand-foot skin reactions (HFSR) may be related to the activity of bevacizumab and sorafenib. We hypothesized that these toxicities would correspond to favorable outcome in these drugs, that HT and HFSR would coincide, and that VEGFR2 genotypic variation would be related to toxicity and clinical outcomes.

METHODS
Patients and treatment
The analyses were performed on genomic DNA from 178 patients (143 males and 35 females) with solid tumors who received sorafenib (VEGFR2 inhibitor) and/or bevacizumab (anti-VEGF) with or without other agents....cont'd (excerpt from pdf file)

Conclusions: This study suggests that HT and HFSR may be markers for favorable clinical outcome, HT development may be a marker for HFSR, and VEGFR2 alleles may be related to the development of toxicities during therapy with bevacizumab and/or sorafenib.

(full free access) "Physician As Typist" -- from the series: The Art of Oncology

"I stare at the primary care physician’s note in front of me. I have been concerned about our mutual patient’s hypertension. I believe it has been exacerbated by the use of bevacizumab, and I have referred her back for additional management. All I need is an acknowledgment of the problem and a treatment plan. The note that I have received is three pages long and is filled with unrelated laboratory values, scan results, and jumbled-up text....."

Q&A: Cardiac Catheterization for Cancer Patients - Cancerwise | Cancer blog from MD Anderson Cancer Center

Why is it important to have a cath lab in a cancer center?

As a result of their disease and the treatments they receive, cancer patients are different from regular cardiovascular patients. 

Is it strictly for diagnostic purposes?

No, it can be used for both diagnostic purposes and treatment. It helps recognize heart failure, pulmonary hypertension and valve disease, among other heart problems. It can also be used to implant pacemakers, defibrillators and intra-aortic balloon pumps, as well as perform pericardiocentesis (a procedure that uses a needle to remove fluid surrounding the heart) and endomyocardial biopsies (a procedure for patients with possible heart failure after chemotherapy, where a minimal piece of heart muscle is analyzed under the microscope). 

Cardiovascular Safety of VEGF-Targeting Therapies: Current Evidence and Handling Strategies -- Girardi et al., 10.1634/theoncologist.2009-0235 -- The Oncologist

Abstract
Treatment with the angiogenesis inhibitors bevacizumab, sunitinib, and sorafenib as single agents or in combination with conventional chemotherapy is becoming a cornerstone of modern anticancer therapy. However, the potential toxicity of these drugs, mainly to the cardiovascular system, is still being investigated. Patient assessment at baseline, of crucial importance in candidates for treatment, involves the evaluation of risk factors and screening for past or present cardiovascular disease. Strict monitoring of treatment-related adverse effects must be conducted in order to allow the early detection of cardiovascular toxicities and their prompt medication. In the present paper, the most frequent cardiovascular toxicities and their underlying mechanisms are investigated, with a view to providing indications for effective patient management.

Initial Assessment, Surveillance, and Management of Blood Pressure in Patients Receiving Vascular Endothelial Growth Factor Signaling Pathway Inhibitors -- Maitland et al. 102 (9): 596 -- JNCI Journal of the National Cancer Institute

Box 1. Summary recommendations

1. Conduct and document a formal risk assessment for potential cardiovascular complications before vascular endothelial growth factor signaling pathway (VSP) inhibitor treatment. The assessment should include standardized blood pressure measurements (two separate sessions are suggested) and thorough history and examination to assess specific cardiovascular risk factors, and directed laboratory studies as indicated. (Table 2 summarizes the risk factors.) The purpose of this evaluation is to guide the physician and patient in determining the appropriate intensity of monitoring and control of blood pressure elevations. This provides an important opportunity to address comorbidities that through more attentive management could help prolong the patient's life and support more aggressive anticancer therapy.
   
2. Recognize that preexisting hypertension will be common in cancer patients and should be identified and addressed before initiation of VSP inhibitor therapy. Given the suspected importance of pretreatment intervention in the management of VSP inhibitor–induced blood pressure elevations, properly collected, objective, office measurements or more thorough evaluations for isolated office hypertension (also known as "white coat hypertension") should guide the risk assessment rather than patient and/or physician speculation and dismissal.
   
3. Actively monitor blood pressure throughout treatment with more frequent assessments during the first cycle of treatment. The first cycle is typically when the bulk of the blood pressure elevation is expected to occur and when most patients unexpectedly present with elevations warranting treatment even in the absence of preexisting cardiovascular risk factors.
   
4. The goal for hypertension control in patients receiving VSP inhibitor therapy is a maximum blood pressure of 140/90 mmHg, and efforts to reach this goal should begin before initiation of VSP inhibitor therapy. The recommendation for a goal of maintaining blood pressure less than 140/90 mmHg is based on prudence and consistency with general guidelines. As per the risk stratification considerations, targets should be adjusted lower for patients with multiple preexisting risk factors for adverse consequences of high blood pressure. For example, for patients with diabetes and/or chronic kidney disease, a goal blood pressure of less than 130/80 mmHg is the current public health recommendation.
   
5. Manage blood pressure elevations aggressively to avoid the development of complications associated with excessive/prolonged elevations. Management requires attention to proper agent selection, dosing, and scheduling of follow-up to ensure efficacy and to control adverse effects of the antihypertensive agent. The panel suggests that at any time, if the oncologist or responsible medical team member has any difficulty in helping the patient progress to the goal blood pressure of 140/90 mmHg, consultation with the local hypertension specialist (cardiologist, nephrologist, endocrinologist, or certified hypertension specialist) should be obtained promptly.

Renal outcomes with different fixed-dose combination therapies in patients with hypertension at high risk for cardiovascular events (ACCOMPLISH)

Renal outcomes with different fixed-dose combination therapies in patients with hypertension at high risk for cardiovascular events (ACCOMPLISH): a prespecified secondary analysis of a randomised controlled trial.

INTERPRETATION: Initial antihypertensive treatment with benazepril plus amlodipine should be considered in preference to benazepril plus hydrochlorothiazide since it slows progression of nephropathy to a greater extent.
FUNDING: Novartis