Key result
Anti-VEGF-induced hypertension incidence in renal cell carcinoma varies up to ~59% by diagnostic criteria.
Why the study?
Do specific patient characteristics predict anti-VEGF drug-induced hypertension similarly across different diagnostic criteria in patients with RCC?
Observational (n=1,102)
Open-label
1:1
Yes
Do specific patient characteristics predict anti-VEGF drug-induced hypertension similarly across different diagnostic criteria in patients with RCC?
The incidence and predictors of anti-VEGF drug-induced hypertension vary significantly depending on the diagnostic criteria used, which may impact the assessment of interactions between these drugs, hypertension, and cancer outcomes.
Definition-dependent incidence of anti-VEGF hypertension in RCC cautions against unadjusted comparisons; leaves open standardized criteria for outcome studies.
Background: There is inconsistency in the criteria used to define anti-vascular endothelial growth factor (VEGF) drug-induced hypertension (AVEGF-HT) in published studies. It is unknown whether specific patient characteristics similarly predict AVEGF-HT using different criteria. Methods: We assessed the associations between clinical and demographic factors ( n = 22) and AVEGF-HT, using six criteria based on predefined on-treatment blood pressure (BP) thresholds or absolute BP elevations versus baseline, in a post hoc analysis of a phase III trial of 1102 patients with renal cell carcinoma (RCC) randomized to pazopanib or sunitinib (COMPARZ study). Results: The cumulative incidence of AVEGF-HT at any time while on treatment ranged between 14.8% [criterion: grade ⩾3 toxicity, National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) v3.0] and 58.8% (criterion: absolute systolic BP increase ⩾20 mmHg versus baseline). After adjusting for anti-VEGF treatment and baseline BP, the number of significant ( p < 0.05) predictors ranged between one (criterion: absolute systolic BP increase ⩾20 mmHg, on-treatment systolic BP ⩾140 mmHg and diastolic BP ⩾90 mmHg) and nine (criterion: grade ⩾3 toxicity, NCI CTCAE v3.0). Age, use of antidiabetic drugs and use of antihypertensive drugs each significantly predicted four AVEGF-HT criteria. By contrast, sex, smoking, heart rate, proteinuria, Karnofsky performance status, and use of thiazide diuretics did not predict any criterion. Conclusions: There was a significant variability in the incidence, number and type of predictors of AVEGF-HT, using six different criteria, in a post hoc analysis of the COMPARZ study. The use of specific criteria might affect the assessment of the interaction between anti-VEGF drugs, AVEGF-HT and cancer outcomes.
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Mangoni et al. (2018) conducted an observational in Renal cell carcinoma (n=1,102). Baseline clinical and demographic factors vs. Reference groups for each factor was evaluated on Incidence of anti-VEGF drug-induced hypertension (AVEGF-HT) at any time while on treatment plus 28 days after cessation, using six different criteria. In patients with renal cell carcinoma treated with anti-VEGF drugs, the cumulative incidence of induced hypertension varied significantly from 14.8% to 58.8% depending on the criteria used, with age and baseline medications predicting risk.
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