Hypertensive Profile of Metastatic Colorectal Carcinoma Patients Treated with Bevacizumab—A Prospective Study

Abstract

Background: Bevacizumab is a recombinant humanized monoclonal antibody which targets Vasculoendothelial growth factor (VEGF)-A and prevents its binding to VEGF receptor 2 (VEGFR 2). It is approved in the first and second line treatment of metastatic colorectal cancer along with combination chemotherapy. Hypertension is an on-target and a common side effect of the treatment with bevacizumab. The true incidence of bevacizumab induced hypertension and its grading remains unclear due to paucity of prospective studies in this regard. In our institution, majority of metastatic colorectal cancer patients receive bevacizumab along with cytotoxic chemotherapy. In Indian, a context prospective study on this topic is negligible; so we find it to be of high importance. Objectives: We have conducted a prospective observational study of all metastatic colorectal patients receiving bevacizumab with chemotherapy and satisfying the eligibility criteria. The objective of the study was to assess the incidence and the pattern of hypertension. Materials & Methods: Patients receiving bevacizumab with FOLFOX (5 Fluorouracil, Calcium Leucovorin & Oxaliplatin) or CapeOX (Capecitabine & Oxaliplatin) chemotherapy for metastatic colorectal cancer were enrolled in the study; blood pressure was monitored before bevacizumab administration and also for the next seven days. This was done for all the chemotherapy cycles. Results: 100% of patients developed hypertension of any grade and 20% received treatment as a part of newly detected hypertension. Majority of the patients had grade 1 hypertension. Other grade of hypertension was grade 2. The blood pressure peaked on 6 th day of bevacizumab administration. Conclusions: Hypertension of any grade may develop in bevacizumab treated patients. The incidence is very high and it may reach even up to 100% if prospectively and meticulously evaluated for longer period of time.