Pre-existing hypertension should not be a barrier to starting bevacizumab. That is the conclusion of a new set of UK-specific recommendations on the management of hypertension in patients with ovarian and cervical cancer receiving bevacizumab.
The recommendations have been developed by a group with representation from oncology, cardiology, general practice, and nursing, and include the following:
Considerations before bevacizumab treatment
- Bevacizumab can be started in patients with a clinic blood pressure (BP)
- If average ambulatory or home BP monitoring (ABPM/HBPM) BP over ≥4 days is ≥150/95 mm Hg, delay bevacizumab.
- Initiate bevacizumab when ABPM/HBPM BP is
- If BP remains ≥150/95 mm Hg, step up antihypertensive treatment.
- Initiated 5 mg amlodipine daily in antihypertensive-naive patients and reassess after ≥2 weeks.
- Management of hypertension should be initiated in the oncology unit and then transferred to primary care.
Consideration during treatment
- Bevacizumab can be initiated when pre-infusion BP is
- No antihypertensive treatment is required in antihypertensive-naive patients.
- Patients already on antihypertensive drugs should continue treatment.
- If clinic BP is ≥160/100 mm Hg or there has been a marked increase of ≥20 mm Hg systolic or ≥10 mm Hg diastolic, bevacizumab dose should be omitted.
- If average ABPM/HBPM BP is
- If BP remains ≥150/95 mm Hg, initiated amlodipine 5 mg daily in antihypertensive-naive patients and reassess after ≥2 weeks.
- If clinic BP remains ≥160/100 mm Hg and/or ABPM/HBPM is ≥150/95 mm Hg, antihypertensive treatment should be stepped up.
- If BP fails to drop below these thresholds despite treatment with ≥3 antihypertensive drugs, or if there are multiple drug intolerances, consider referral to a clinician with a special interest in hypertension.
- Antihypertensive-naive patients with BP ≥220 mm Hg systolic should be checked for functional deterioration of vital organs.
- Bevacizumab should be permanently withheld in cases of malignant-phase hypertension, hypertensive crisis, or hypertensive encephalopathy.
Considerations after bevacizumab
- Bevacizumab-associated hypertension typically resolves after treatment is complete.