Published: 3 December 2020
Publications
Dissecting systemic VEGF inhibitors: effects on arteries
Published: 3 December 2020
Prescriber Update 41(4): 76
December 2020
Background
Recently, an association between the use of vascular endothelial growth factor (VEGF) inhibitors and aneurysms and artery dissections has been identified. However, no cases have been reported in New Zealand to date.
VEGF inhibitors
Systemic VEGF inhibitors are used to treat a variety of cancers. VEGF inhibitors are thought to inhibit tumour growth by:1
- preventing endothelial cell proliferation and depriving the tumour vascular supply
- improving chemotherapy delivery by normalising tumour vasculature.
Table 1 shows the currently approved systemic VEGF inhibitors in New Zealand.
Table 1: Approved systemic VEGF inhibitors in New Zealand
| Active substance | Brand name |
|---|---|
| Axitinib | Inlyta |
| Nintedanib | Ofev |
| Bevacizumab | Avastin |
| Pazopanib | Votrient |
| Regorafenib | Stivarga |
| Sorafenib | Nexavar |
| Sunitinib | Sutent |
| Tivozanib | Fotivda |
Source: Medsafe Product/Application search. URL: medsafe.govt.nz/regulatory/dbsearch.asp (accessed 24 September 2020).
Aneurysm and artery dissection
An aneurysm is a ballooning of a weakened area in a blood vessel. Aneurysms may rupture, resulting in internal bleeding.
An artery dissection is a tear in the artery lining. As the tear becomes larger, it forms a pouch where blood can accumulate. This can cause blood clots or block the flow of blood.2
Hypertension, smoking and high cholesterol are modifiable risk factors for aneurysms and artery dissections.3 Managing these risk factors can lower the risk of occurrence. Non-modifiable risk factors include increasing age and a family history of aneurysm and artery dissection.3
The mechanism by which VEGF inhibitors can cause aneurysms and artery dissection is unclear but may include aggravation of pre-existing hypertension and/or changes in the structure of the vascular endothelium.3,4
Interestingly, aneurysms and artery dissections have also been reported in patients taking VEGF inhibitors without hypertension.3,4
Minimising the risk
To minimise the risk of aneurysms and artery dissections in patients treated with VEGF inhibitors:
- regularly monitor blood pressure during treatment. Antihypertensive therapies should be initiated or adjusted according to blood pressure treatment guidelines5
- refer smokers to a smoking cessation service.3
References
- Kuo CJ. 2020. Overview of angiogenesis inhibitors. In: UpToDate 14 May 2020. URL: uptodate.com/contents/overview-of-angiogenesis-inhibitors (accessed 24 September 2020).
- John Hopkins Medicine. Neurology and Neurosurgery – Arterial dissection. URL: hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/pediatric_neurovascular/conditions/arterial%20dissection.html (accessed 24 September 2020).
- Medicines and Healthcare products Regulatory Agency. 2020. Systemically administered VEGF pathway inhibitors: Risk of aneurysm and artery dissection. Drug Safety Update 13(12): 1. URL: gov.uk/drug-safety-update/systemically-administered-vegf-pathway-inhibitors-risk-of-aneurysm-and-artery-dissection (accessed 24 September 2020).
- Prescrire. 2020. VEGF inhibitors: arterial aneurysm and dissection. Prescrire International 29(218): 214.
- Pandy AK, Singhi EK, Arroyo JP, et al. 2018. Mechanisms of VEGF-inhibitor associated hypertension and vascular disease. Hypertension 71(2): e1–e8. DOI: 10.1161/HYPERTENSIONAHA.117.10271 (accessed 20 October 2020).
