Hypertension is a common toxicity with almost all anti-VEGF agents, and although it is often referred to in discussions, its management is rarely interrogated in a granular fashion. As such, we sought to identify how clinicians approach a patient receiving bevacizumab who develops Stage I hypertension (155/90 mm Hg). Somewhat surprisingly, 85% of oncologists, including Dr Ramalingam, would hold the drug until the blood pressure could be better controlled despite the fact that the package insert only suggests this approach in patients with “severe” hypertension. Dr Wakelee takes a different tack and adds an ACE inhibitor while continuing the drug.

Dahlberg SE et al. Clinical course of advanced non-small-cell lung cancer patients experiencing hypertension during treatment with bevacizumab in combination with carboplatin and paclitaxel on ECOG 4599. J Clin Oncol 2010;28(6):949-54. Abstract

Izzedine H et al. Management of hypertension in angiogenesis inhibitor-treated patients. Ann Oncol 2009;20(5):807-15. Abstract

Suenaga M et al. Optimal use of antihypertensive agents in management of bevacizumab-associated hypertension. Gastrointestinal Cancers Symposium 2011;Abstract 614.