Impact of vascular endothelial growth factor inhibitor-induced hypertension on continued cancer treatment: a systematic review and meta-analysis.

The administration of bevacizumab, ramucirumab, and aflibercept increases the incidence of hypertension; however, the risk of discontinuation of cancer therapy due to hypertension from these medications remains unclear. A systematic review and meta-analysis were conducted to assess the incidence and risk of hypertension associated with bevacizumab, ramucirumab, and aflibercept, as well as the risk of treatment discontinuation due to hypertension. Phase III randomized controlled trials (RCTs) of these therapies published through November 5, 2024, were identified through searches in PubMed, Cochrane Library, and Web of Science databases. The meta-analysis included 57 RCTs comprising 34,145 patients who received bevacizumab, ramucirumab, or aflibercept. The overall incidence of hypertension was 28% (95% confidence interval [CI]: 22-34%) for all-grade hypertension and 9% (95% CI: 7-11%) for grade ≥3 hypertension. Compared to control groups, treatment with these agents was associated with an increased risk of all-grade hypertension (odds ratio [OR]: 4.5; 95% CI: 3.7-5.5) and grade ≥3 hypertension (OR: 5.0; 95% CI: 4.0-6.3). The incidence of treatment discontinuation due to hypertension was 1% (95% CI: 1-2%), with a risk difference of 1.60% (95% CI: 0.76-2.38). VEGF inhibitor therapy-induced hypertension has been suggested to increase the risk of cancer treatment discontinuation. Therefore, careful monitoring and management of blood pressure in patients receiving these agents is essential.