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Tolerability of Antiangiogenic Therapy
Unlike chemotherapy, which produces severe side effects, angiogenesis inhibitors are generally well tolerated. Nonetheless, these newer therapies also carry side effects that warrant careful monitoring and management by a physician or nurse.

Elevated blood pressure (hypertension) is the most common side effect of antiangiogenic drugs that are designed to inhibit VEGF. Some patients may need to be given blood pressure lowering medications, but most will not have to stop their cancer treatment. Other side effects experienced by a substantial proportion of patients taking either sunitinib or sorafenib include diarrhea, fatigue, hypertension, and rash, particularly on the hands and feet.13 Some patients may also experience changes in hair texture or hair color.

Monitoring of thyroid gland functioning is advised for patients on sunitinib due to the risk for developing low thyroid function (hypothyroidism). Low thyroid function can contribute to the feeling of fatigue experienced by patients who are being treated with sunitinib, and may cause other effects, such as dry skin. Patients on sunitinib, particularly those with a history of heart problems, should also receive monitoring of cardiac function while taking the drug.

Bevacizumab therapy, in addition to causing hypertension, is also associated with protein in the urine (proteinuria), an increased risk of blood clotting and bleeding problems, and much less frequently, wound healing complications and gastrointestinal perforation. For this reason, physicians will usually avoid giving bevacizumab shortly prior to or following surgery. Drugs that inhibit mTOR, including temsirolimus and everolimus, affect metabolism of fat and sugar and can cause increased blood levels of both cholesterol and sugar. These metabolic effects can be readily managed with lipid- and glucose-lowering drugs.


Last updated May 29, 2011