Practice patterns of bevacizumab-induced hypertension in cancer patients.

Abstract

e20664 Background: Vascular endothelial growth factor (VEGF) inhibitors such as bevacizumab (BV) can result in side-effects such as hypertension (HTN), proteinuria and acute kidney injury (AKI). The objectives are to evaluate practice patterns of BV-induced HTN; to assess frequency of BV dose reduction, withdrawal and delay due to HTN, proteinuria and AKI; and to determine the time course for initial resolution of BV-induced HTN, proteinuria and AKI. Methods: We retrospectively reviewed random charts of 75 cancer patients (pts) treated with BV from 1/1/2009 to 9/30/2011. This included demographic, clinical and outcome parameters. Descriptive statistics were utilized. Results: 37 (56%) were males with median age 56 years (range 19-84). Most had lung (14, 19%), breast (11, 15%), and colorectal cancer (10, 13%). 69 (92%)had metastatic disease. 70 (93%) pts were on BV with other antineoplastic agents. 37 (49%) had a diagnosis of HTN at study entry. The median days from first BV treatment (tx) to first hypertensive reading was 7 (0-279) and days to receiving new or dose increase of HTN meds was 49 (0-283). 44 (59%) pts had 2 consecutive readings ≥ 140 or ≥ 90 mmHg during BV tx and 49 (65%) during post-tx follow-up of 6 months or less. 14 pts received new or dose increase of HTN meds during tx. The most frequent HTN meds used were diuretics (26%), beta blockers (21%) and calcium channel blockers (17%). The average number of new HTN meds at last BV tx was 1.5. No pt had BV dose reduced due to HTN, proteinuria or AKI. BV was withdrawn in 2 (3%) due to HTN, 2 (3%) due to proteinuria and 1 (1%) due to AKI. 5 pts had a delay due to HTN (4) and AKI (1). 57% (8 /14) of pts receiving additional HTN meds during BV tx had first dose decrease of additional HTN meds post-tx at a median of 30.5 (11-162) days. The median number of days to resolve first proteinuria and first AKI was 20 (1-193) and 14 (0-34) days, respectively. Conclusions: HTN occurred in a majority with few receiving extra HTN meds although meeting HTN criteria. Patients continued to have HTN post-tx. However, despite HTN, few stopped BV due to cardiovascular events. Further education regarding HTN guidelines may be necessary and should be considered.