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Tolerability of Antiangiogenic Therapy
Antiangiogenic drugs are generally well tolerated relative to traditional chemotherapy and radiation treatments for cancer. Nonetheless, these treatments still cause adverse effects that must be carefully monitored and managed. The primary adverse effect of many antiangiogenic therapies is elevated blood pressure (hypertension). Some patients may require standard blood pressuring lowering medications while on treatment, but most do not have to stop antiangiogenic therapy due to hypertension.

Bevacizumab, which is not yet FDA approved for liver cancer, can also cause increased protein in the urine (proteinuria), and a risk for mild blood clotting and bleeding problems, most often nosebleeds. Since the liver is rich with blood vessels, patients with liver cancer, and particularly those who have had surgery to remove a tumor, are at an increased risk for serious bleeding events. Antiangiogenic therapy should therefore be used with caution in patients who recently underwent surgical resection of a tumor.

Sorafenib, which is the only FDA approved angiogenesis inhibitor for liver cancer, can cause fatigue, diarrhea, nausea, and rash/skin reactions, particularly on the palms and soles of the feet.9 This skin condition, called hand-foot skin reaction, should be managed by an experienced dermatologist familiar with the skin effects of sorafenib. Certain topical creams, good foot care, and wearing comfortable socks and shoes can help alleviate this condition. Some patients on sorafenib may also experience changes in hair color and texture.


Last updated May 29, 2011