John Libbey Eurotext

Hépato-Gastro & Oncologie Digestive

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Towards an optimization of antiangiogenic use in clinical practice Volume 17, special issue 5, Cancer colorectal : acquis thérapeutiques récents

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Hôpital Robert Debré CHU Reims, France Hépato-gastroentérologie et cancérologie digestive Avenue du Général Koenig 51092 Reims Cedex

Recognition of the key role of angiogenesis in tumor growth led to the development of several drugs targeting the Vascular Endothelial Growth Factor (VEGF) proangiogenic pathway. Side effects that were unknown with classical cytotoxic agents, in particular cardiovascular side effects, require a specific management. These side effects, even moderate ones, may affect patients quality of life and treatment has sometimes to be postponed or even cancelled, which may prove harmful to patients. Hypertension and proteinuria are common side effects of antiangiogenics. An interdisciplinary French working group issued clinical practice guidelines for the management of vascular and renal side effects of antiangiogenics that will be rephrased in this review. Blood pressure must be assessed by ambulatory monitoring. Diagnostic and therapeutic management of hypertension should be done according to the guidelines issued by the French National Authority for Health. As VEGF has a key role in wound healing, bevacizumab must not be given five to six weeks before and four weeks after major surgery, tooth extraction or polypectomy; wound healing must be checked. Patients must be informed about (rare) serious side effects: arterial thrombosis, digestive perforation, bleeding and complicated hypertension. Oncologists, family physicians, cardiologists and nephrologists should collaborate closely and make use of a common logbook.