nintedanib and Hypertension

You are consulted to evaluate a 56-year-old woman with known Raynaud's phenomenon, finger swelling of several; months' duration, and new hypertension with a blood pressure of 160/100 mm/Hg. She also reports progressive shortness of breath. Physical examination reveals telangiectasias, sclerodactyly, and proximal skin sclerosis (thick shiny skin on the chest and upper arms), and bibasilar crackles are found on chest examination. Laboratory tests reveal evidence of microangiopathic hemolytic anemia, thrombocytopenia, and elevation of the serum creatinine level (previously normal), and chest computed tomography shows evidence of ground-glass opacification in both lower lung fields.

Topics: Adrenergic alpha-Antagonists; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Antibodies, Antinuclear; Antibodies, Monoclonal, Humanized; Antihypertensive Agents; Antirheumatic Agents; Calcium Channel Blockers; Complement C3; Complement C4; Complement Inactivating Agents; Cyclophosphamide; Endothelin Receptor Antagonists; Humans; Hypertension; Indoles; Lung Diseases, Interstitial; Plasma Exchange; Protein Kinase Inhibitors; Raynaud Disease; Renal Insufficiency; RNA Polymerase III; Scleroderma, Diffuse; Scleroderma, Limited; Stem Cell Transplantation; Tomography, X-Ray Computed; Transplantation, Autologous; Vasodilator Agents

Novel agents to reduce angiogenesis by targeting vascular endothelial growth factor and other proangiogenic signaling pathways are being developed for advanced nonsmall cell lung cancer. Antibody-based therapies (e.g., aflibercept) and multitargeted tyrosine kinase inhibitors (e.g., sorafenib, sunitinib, and BIBF 1120) are being evaluated in phase III clinical trials. Some antiangiogenic agents have demonstrated distinct profiles in producing a variety of nonhematologic toxicities, including bleeding/hemorrhage, venous and arterial thromboembolic events, gastrointestinal perforation, hypertension, and proteinuria. Elucidating the molecular basis of these toxicities may lead to clinical benefits by improving patient selection and allowing for the development of effective prevention and management strategies.

Topics: Angiogenesis Inhibitors; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Benzenesulfonates; Bevacizumab; Blood Coagulation Disorders; Carcinoma, Non-Small-Cell Lung; Humans; Hypertension; Indoles; Intestinal Perforation; Lung Neoplasms; Niacinamide; Phenylurea Compounds; Proteinuria; Pyridines; Receptors, Vascular Endothelial Growth Factor; Recombinant Fusion Proteins; Sorafenib; Vascular Endothelial Growth Factor A; Wound Healing