[Renovascular effects of antiangiogenic drugs]

[Angiogenesis inhibitors: mechanism of action and nephrotoxicity]

Tumoral angiogenesis is a key mechanism involved in the growth and spread of cancer cells. The development of angiogenesis inhibitors, particularly those targeting the Vascular Endothelial Growth Factor (VEGF) pathway, has improved the prognosis and survival of many cancer patients since they were approved in 2005 in France. Vascular Endothelial Growth Factor inhibitors have different mechanisms of action, targeting either the ligand (e.g. bevacizumab, anti-Vascular Endothelial Growth Factor monoclonal antibody; aflibercept, recombinant anti-Vascular Endothelial Growth Factor fusion protein), or its receptors such as tyrosine kinase inhibitors (e.g. sunitinib or sorafenib). These treatments can be combined with conventional chemotherapy, or other anti-cancer therapies, and are associated with variable tolerance depending on the patient's clinical condition and comorbidities. Additionally, angiogenesis inhibition may be associated with cardiovascular and/or kidney toxicity and therefore special monitoring is needed during the treatment duration. Development of hypertension and proteinuria are the commonest renal side effects; these are generally manageable and reversible when treatment is stopped. However, more severe toxicities have been reported such as acute kidney injury, glomerular and/or vascular insults such as thrombotic microangiopathy, and more rarely tubulointerstitial damage. The prescribing physician should be aware of these potentially serious. This article describes the mechanisms of action of antiangiogenic agents and their potential toxicities, with particular respect to the kidneys.

Holistic Regulation of Angiogenesis with Chinese Herbal Medicines as a New Option for Coronary Artery Disease

Effectively improving myocardial blood flow and controlling atherosclerotic plaque have always been key and difficult points in the prevention and treatment of coronary artery disease (CAD). Although “therapeutic angiogenesis” is regarded as a promising approach for ischemic heart disease by improving blood flow, angiogenesis itself can induce the destabilization of atherosclerotic plaque, which reflects the double-edged role of angiogenesis. Modulating the balance of angiogenesis can be an important target for CAD treatment. Traditional Chinese medicine (TCM) emphasizes the holistic view and dynamic balance of the body. Furthermore, the principle of activating blood circulation and removing blood stasis (ABCRS) is closely connected with angiogenesis and CAD. Recent research suggests that Chinese herbal medicines for ABCRS are effective in balancing the regulation of angiogenesis. This review presents the progress of recent research on the angiogenesis regulation with Chinese herbal medicines for ABCRS in CAD. Moreover, this review demonstrates that Chinese herbal medicines for ABCRS can not only promote angiogenesis in the ischemic area to improve myocardial blood flow but also alleviate angiogenesis to stabilize plaque in atherosclerosis, which reflects the holistic regulatory role in CAD treatment.

[Monitoring of hypertension in patients orally treated by angiogenesis inhibitor in daily practice]

OBJECTIVE

The aim of this study is to measure the monitoring and the incidence of renovascular effects of angiogenesis inhibitors in real population.

METHOD

Are included in this descriptive, monocentric, practical study, patients of 18 years old and more, orally treated by angiogenesis inhibitors and monitored in consultation by clinician nurses. The main interest variable is the incidence of hypertension at three months of treatment.

RESULTS

From January, 2011 to July, 2014, 324 patients have been included, whose 53% are men. Mean age is 62±13 years old. Antecedents are: 37% of hypertension, 17% of chronic renal insufficiency, 21% of nephrectomy, 13% of diabetes. Most frequent cancers are kidney (31%), liver (23%) and breast (16%). Most used molecules are: sorafenib (30%), sunitinib (23%) and everolimus (16%). Blood pressure has been measured at the beginning of the treatment in 157 patients (48%). Among them, during the first three months of treatment, 55 (35%) present hypertension according to the oncological definition and 59 (38%) according to the classical definition; 30 patients (19%) are considered as hypertensive according to only one of the two definitions. In multivariable analysis, variables significantly associated with hypertension are: age (OR=1.04; 95% CI 1.02-1.08; P<0.01) and antecedent of nephrectomy (OR=4.29; 95%CI 1.86-9.92; P<0.01).

CONCLUSION

In this cohort, only 48% of the patients had blood pressure determination before treatment. Hypertension under angiogenesis inhibitors is probably underestimated. Age and antecedent of nephrectomy seem to be correlated with the occurrence of hypertension.