Real-world incidence, severity, and management of bevacizumab-induced hypertension in patients with colorectal cancer

Introduction: Bevacizumab is a vascular endothelial growth factor (VEGF) inhibitor that is commonly used as a first line treatment in metastatic colorectal cancer. VEGF inhibition halts angiogenesis and tumor proliferation, but is also associated with adverse cardiovascular effects such as hypertension. The true incidence and severity of bevacizumab-induced hypertension is not well quantified outside of clinical trials. Additionally, literature is lacking on the most appropriate agent to treat patients experiencing bevacizumab-induced hypertension. Methods: This single-center, retrospective chart review evaluated patients treated with bevacizumab for metastatic colorectal cancer between April 4, 2014 and May 31, 2020. The study assessed the incidence and severity of bevacizumab-induced hypertension in patients with colorectal cancer and identified prescribing patterns of antihypertensive agents in this patient population. Blood pressure data and medication history was collected at 4 week time intervals (+/- 2 weeks) for up to 24 weeks post-initiation of bevacizumab. Results: Of the 77 patients identified, 33 (42.9%) had a diagnosis of hypertension at baseline. At week 4, 30 (39.0%) patients presented with CTCAE grade ≥ 1 (any grade) hypertension and 3 (3.9%) presented with CTCAE grade ≥ 3 (grade 3/4) hypertension. The most common antihypertensive prescribed to treat bevacizumab-induced hypertension was the calcium channel blocker, amlodipine, with 12 (15.6%) patients initiated on this medication. Conclusion: Treatment with bevacizumab is associated with high frequencies of any grade and grade 3/4 HTN in metastatic colorectal cancer. Overall, few antihypertensives were initiated or adjusted during the 24-week follow-up, suggesting a potential undertreatment of VEGF inhibitor-induced HTN. Our results inform future, prospective studies to continue to deduce the optimal antihypertensive regimen and the true incidence and severity of bevacizumab-induced hypertension in the real world setting.