Sunitinub May Raise Blood Pressure in Patients With Kidney Cancer

Sunitinib (Sutent)—a vascular endothelial growth factor (VEGF) activity blocker prescribed for patients with advanced malignances and short life expectancies—can cause high blood pressure in patients with kidney cancer, French researchers report.  This mirrors last month’s study revealing sunitinib increased blood pressure and the risk of heart failure among patients with stomach cancer.  “Patients taking sunitinib and other similar [drugs] may experience increases in blood pressure of 15 to 25 percent,” said study author Dr. Michel Azizi, professor of vascular medicine at Georges Pompidou European Hospital, Paris.  The report appears in the January 3rd issue of the New England Journal of Medicine.  Azizi and his team used home blood pressure monitoring, with results sent automatically by telephone to the hospital and found an immediate, marked increase in pressure in 14 patients with kidney cancer who were treated with 50 milligrams of sunitinib daily for four weeks.  This sunitinib <"">side effect  was not seen when pressure was measured in a physician’s office, Azizi said adding, “It started within four to seven days of the first cycle of sunitinib, disappeared within two weeks of treatment discontinuation, and recurred during the following treatment cycle.”

Other VEGF inhibitors have been developed, including bevacizumab (Avastin), and while these drugs are promising in fighting several types of cancer, they are associated with side effects, including high blood pressure, bleeding, gastrointestinal perforation, wound-healing complications, and clotting, Azizi noted.  Azizi thinks that, despite the increase in blood pressure, the cancer-fighting benefits of sunitinib outweigh the risks.  For those with normal pressure, the increase is manageable with medication, he noted.  “Our observations show that in initially hypertensive patients the additional sunitinib-related increase in blood pressure is not easy to control and that recommended blood pressure targets are not easily achievable despite administration of multiple anti-hypertensive drugs,” Azizi said.  Rapid increases in blood pressure should be expected for every patient treated with sunitinib, Azizi said, so close monitoring is needed.  “We strongly advise the routine use of home blood pressure monitoring in standard care for early detection and accurate assessment of blood pressure changes in patients treated with any sunitinib-like drugs,” he added.

Dr. Ming Hui Chen is an assistant professor of medicine at Harvard Medical School, a cardiologist at Children’s Hospital Boston, and lead author of the December sunitinib study published in The Lancet.  Chen feels patients taking sunitinib need to have their blood pressure monitored.  “In general, hypertension is one of the most treatable of all medical conditions.  VEGF inhibitor-associated hypertension is not uncommon, but in my experience a very manageable one,” Chen said, adding:  “We should not lose sight that this type of anti-cancer therapy is effective for patients with metastatic renal cell and gastrointestinal stromal tumors.”

Sunitinib’s maker, Pfizer Inc., agreed these heart risks do exist; however, the company added that the events “were medically manageable in most patients and underscore the importance of having a collaborative team of health-care professionals working together to appropriately manage patients who have limited available options” in treating their cancer.

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