Hypertension management in patients with renal cell cancer treated with anti-angiogenic agents

Inhibitors of the vascular endothelial growth factor (VEGF-IS) signalling pathway have fundamentally changed the treatment of metastatic renal cell carcinoma (mRCC). Hypertension is one of the most common side effects of VEGF-IS and has been reported with almost every VEGF-I used for treatment to date. The exact mechanism of VEGF-I-induced hypertension appears complex and multifactorial, and it remains to be fully explained. No randomized clinical trials are available to guide the management of hypertension during VEGF-I treatment in mRCC patients. The guiding principles suggested here summarize the consensus of opinions on the diagnosis and management of VEGF-I-induced hypertension during treatment of mRCC obtained from an expert working group composed of 4 Canadian medical oncologists and 5 Canadian hypertension specialists. The Canadian Hypertension Education Program guidelines, available literature, and expert opinion were used to develop the guiding principles.