Initial assessment, surveillance, and management of blood pressure in patients receiving vascular endothelial growth factor signaling pathway inhibitors.
Initial assessment, surveillance, and management of blood pressure in patients receiving vascular endothelial growth factor signaling pathway inhibitors.
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DOI：
10.1093/jnci/djq091
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发表时间：
2010-05-05
期刊：
影响因子：
--
通讯作者：
Cardiovascular Toxicities Panel, Convened by the Angiogenesis Task Force of the National Cancer Institute Investigational Drug Steering Committee
中科院分区：
文献类型：
--
作者：
Maitland ML;Bakris GL;Black HR;Chen HX;Durand JB;Elliott WJ;Ivy SP;Leier CV;Lindenfeld J;Liu G;Remick SC;Steingart R;Tang WH;Cardiovascular Toxicities Panel, Convened by the Angiogenesis Task Force of the National Cancer Institute Investigational Drug Steering Committee
高血压是抑制血管内皮生长因子信号通路（VSP）药物的一种机制性毒性作用。存在将高血压作为慢性疾病进行管理的大量证据，但关于VSP抑制剂引起的急性高血压管理的前瞻性收集数据很少。美国国家癌症研究所的研究药物指导委员会召集了一个跨学科的心血管毒性专家小组来评估这个问题，向癌症治疗评估计划提出进一步研究的建议，并构建治疗医生安全管理的方法。小组审查了：已发表的关于血压（BP）、高血压和特异性VSP抑制剂的文献;主要会议的摘要; VSP抑制剂开发的经验分享;以及高血压护理的既定原则。专家组生成了一份共识报告，包括此处总结的临床问题建议。为了支持尽可能多的患者安全有效地接受VSP抑制剂，专家组提出了四项建议：1）进行并记录潜在心血管并发症的正式风险评估，2）认识到既存高血压在癌症患者中很常见，应在开始VSP抑制剂治疗前进行识别和解决，3）在整个治疗过程中积极监测血压，在第一个治疗周期期间进行更频繁的评估，4）管理血压，大多数患者的目标是低于140/90 mmHg（并降低具有特定预先存在的心血管风险因素的患者的预定目标）。适当的药物选择、剂量和随访时间表应能够维持VSP抑制，同时避免与BP过度或长期升高相关的并发症。
Hypertension is a mechanism-based toxic effect of drugs that inhibit the vascular endothelial growth factor signaling pathway (VSP). Substantial evidence exists for managing hypertension as a chronic condition, but there are few prospectively collected data on managing acute hypertension caused by VSP inhibitors. The Investigational Drug Steering Committee of the National Cancer Institute convened an interdisciplinary cardiovascular toxicities expert panel to evaluate this problem, to make recommendations to the Cancer Therapy Evaluation Program on further study, and to structure an approach for safe management by treating physicians. The panel reviewed: the published literature on blood pressure (BP), hypertension, and specific VSP inhibitors; abstracts from major meetings; shared experience with the development of VSP inhibitors; and established principles of hypertension care. The panel generated a consensus report including the recommendations on clinical concerns summarized here. To support the greatest possible number of patients to receive VSP inhibitors safely and effectively, the panel had four recommendations: 1) conduct and document a formal risk assessment for potential cardiovascular complications, 2) recognize that preexisting hypertension will be common in cancer patients and should be identified and addressed before initiation of VSP inhibitor therapy, 3) actively monitor BP throughout treatment with more frequent assessments during the first cycle of treatment, and 4) manage BP with a goal of less than 140/90 mmHg for most patients (and to lower, prespecified goals in patients with specific preexisting cardiovascular risk factors). Proper agent selection, dosing, and scheduling of follow-up should enable maintaining VSP inhibition while avoiding the complications associated with excessive or prolonged elevation in BP.
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影响因子：
50.5
作者：
Mourad, J. -J.;des Guetz, G.;Levy, B. I.
通讯作者：
Levy, B. I.
DOI：
10.1038/nrclinonc.2009.63
发表时间：
2009-06
期刊：
Nature reviews. Clinical oncology
影响因子：
--
作者：
通讯作者：
--
影响因子：
45.3
作者：
Govindan, Ramaswamy;Crowley, John;Ghalie, Richard
通讯作者：
Ghalie, Richard
影响因子：
168.9
作者：
Lewington, S;Clarke, R;Collins, R
通讯作者：
Collins, R
影响因子：
158.5
作者：
Hurwitz, H;Fehrenbacher, L;Kabbinavar, F
通讯作者：
Kabbinavar, F