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Tyrosine Kinase Inhibitor-Induced Hypertension

  • Cardio-oncology (EH Yang, Section Editor)
  • Published:
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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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Authors and Affiliations

  1. Department of Cardiology, UCLA Health Ventura, 6633 Telephone Rd. Suite 212, Ventura, CA, 93003, USA

    Megha Agarwal, Andre Akhondi & George D. Mitchell

  2. Department of Cardiology, UCLA Health Santa Clarita, 25775 McBean Parkway Suite 202, Santa Clarita, CA, 91355, USA

    Nidhi Thareja

  3. Department of Hematology/Oncology, UCLA Health Ventura, 6633 Telephone Rd. Suite 200, Ventura, CA, 93003, USA

    Melody Benjamin

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  1. Megha Agarwal
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Correspondence to Megha Agarwal.

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Megha Agarwal, Nidhi Thareja, Melody Benjamin, Andre Akhondi, and George D. Mitchell declare they have no conflict of interest.

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This article is part of the Topical Collection on Cardio-oncology

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Agarwal, M., Thareja, N., Benjamin, M. et al. Tyrosine Kinase Inhibitor-Induced Hypertension. Curr Oncol Rep 20, 65 (2018). https://doi.org/10.1007/s11912-018-0708-8

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