Vascular toxicities with VEGF inhibitor therapies-focus on hypertension and arterial thrombotic events

Central to the vascular effects of vascular endothelial growth factor (VEGF) inhibitors are the actions on endothelial cell level. Anti-VEGF therapy targets not only endothelial cell proliferation and permeability, which is the goal to antagonize the formation of new tumor vessels, but also endothelial cellsurvival, vasorelaxation, and platelet activation. The end results are systemic hypertension, accelerated atherosclerosis, and arterial thrombotic events. Various interventions are geared to promote endothelial and vascular health and to reduce the detrimental effects of VEGF inhibitor therapy while maintaining its anti-angiogenic efficacy.269