Hypertension develops in almost one third of adolescents and young adults (AYAs) with kidney cancer treated with sunitinib and more than half of those treated with sorafenib, investigators reported in the Journal of the National Comprehensive Cancer Network. Even AYAs without preexisting conditions are at risk.
Among 1572 patients with unfavorable clear cell or non-clear cell renal carcinoma at high risk for recurrence, 103 were AYAs aged 18 to 39 years. All were randomly assigned to the VEGF inhibitors sunitinib or sorafenib or to placebo.
Over 54 weeks of treatment, the incidence of hypertension was 29% vs 47% among AYAs and non-AYAs, respectively, taking sunitinib and 54% vs 63%, respectively, among those taking sorafenib.
“Overall, hypertension was quite prevalent among AYAs,” according to Wendy J. Bottinor, MD, MSCI, of VCU Health in Richmond, Virginia, and colleagues.
Patients overall treated with sorafenib, regardless of AYA status, had significant 2.2.-fold increased odds of hypertension.
AYA status and female sex were significantly associated with 52% and 26% lower odds of hypertension, respectively.
The incidence of left ventricular systolic dysfunction (LVSD) did not differ significantly between AYAs (3%) and non-AYAs (2%). LVSD was defined as a more than 15% absolute decrease in left ventricular ejection fraction from baseline to below the lower limit of normal.
“These results suggest that younger age and lower comorbidity burden may not reduce the incident risk for cardiovascular toxicities among AYAs receiving VEGFi therapy and suggest a need for further research to understand and mitigate the factors that influence cardiovascular risk in this population,” the investigators wrote.
The study lacked complete data on cardiovascular risk factors, such as diabetes, obesity, and hyperlipidemia, and the use of antihypertensive drugs.
Bottinor WJ, Flamand Y, Haas NB, et al. Cardiovascular implications of vascular endothelial growth factor inhibition among adolescents/young adults in ECOG-ACRIN E2805. JNCCN. 2023;21(7):725-731. doi:10.6004/jnccn.2023.7018