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Current Oncology Reports
Published in: Current Oncology Reports 8/2018

01-08-2018 | Cardio-oncology (EH Yang, Section Editor)

Tyrosine Kinase Inhibitor-Induced Hypertension

Authors: Megha Agarwal, Nidhi Thareja, Melody Benjamin, Andre Akhondi, George D. Mitchell

Published in: Current Oncology Reports | Issue 8/2018

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Abstract

Purpose of Review

The purpose of this paper is to identify commonly used tyrosine kinase inhibitors (TKIs) that are associated with hypertension, primarily, vascular endothelial growth factor (VEGF) signaling pathway (VSP) inhibitors. We review the incidence, mechanism, and strategies for management of TKI-induced HTN. We hope to provide clinicians with guidance on how to manage similar clinical scenarios.

Recent Findings

Many of the newer VSP inhibitors are reviewed here, including cediranib, axitinib, pazopanib, and ponatinib. Trials utilizing prophylactic treatment with angiotensin system inhibitors (ASIs) are discussed as well as recent data showing an improvement in overall survival and progression-free survival in patients on ASIs and TKI-induced hypertension.

Summary

The incidence of TKI-induced HTN among the VEGF inhibitors ranges from 5 to 80% and is dose dependent. Newer generation small-molecule TKIs has a lower incidence. The mechanism of action involves VSP inhibition, leading to decreased nitric oxide and increased endothelin production, which causes vasoconstriction, capillary rarefaction, and hypertension. ASIs and calcium channel blockers are first-line therapy for treatment and are associated with improved overall survival. Nitrates and beta-blockers are associated with in vitro cancer regression; however, there is a paucity of trials regarding their use as an anti-hypertensive agent in the TKI-induced HTN patient population.
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Metadata
Title
Tyrosine Kinase Inhibitor-Induced Hypertension
Authors
Megha Agarwal
Nidhi Thareja
Melody Benjamin
Andre Akhondi
George D. Mitchell
Publication date
01-08-2018
Publisher
Springer US
Published in
Current Oncology Reports / Issue 8/2018
Print ISSN: 1523-3790
Electronic ISSN: 1534-6269
DOI
https://doi.org/10.1007/s11912-018-0708-8

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