Cardiovascular Effects of Anti-angiogenic Drugs

Cancer treatment with anti-angiogenic drugs is causing an emerging cardiovascular health problem in cancer survivors. The 5-year survival rate for patients treated for cancer is currently higher than 60%, but approximately 75% of these cancer survivors have some form of chronic health problems, of which cardiovascular diseases—and in particular high blood pressure—are the leading cause of morbidity and mortality. The vascular endothelial growth factor (VEGF) signaling pathway has become a primary target for the development of drugs that inhibit angiogenesis, which is an important process in tumor tissue invasion and metastasis. Tyrosine kinase inhibitors (TKIs) are presently the most frequently used drugs for anti-angiogenic cancer treatment. This contribution reviews the major mechanisms of angiogenesis as well as the cardiovascular effects of anti-angiogenic drugs with a focus on hypertension and the possible mechanisms underlying TKI-induced hypertension in relation to the role of the microcirculation as an important target of blood pressure control.