Endocrine Abstracts (2009) 20 S22.3

Antiangiogenic medication in malignant pheochromocytoma

Michel Azizi

Hôpital Européen Georges Pompidou, 20-40 rue Leblanc, Paris, France.

Inhibiting tumor angiogenesis by targeting the activity of angiogenic growth factors, especially the vascular endothelial growth factor (VEGF)-A signalling pathway, is a new promising therapeutic strategy for patients with different cancer types. Several VEGF inhibitors have been developed including a humanized anti-VEGF-A monoclonal antibody (bevacizumab), an anti-VEGFR-2 antibody, a VEGF receptor chimeric protein and various small molecules inhibiting VEGFR-2 signal transduction, such as sunitinib or sorafenib. Several of them are now approved for the treatment of cancer, especially for advanced renal and colonic cell carcinomas. Complete/partial response to sunitinib has been reported in very few patients with advanced malignant paraganglioma/pheochromocytoma. The use of these drugs has been associated with several side effects, including early hypertension necessitating close blood pressure monitoring, renal toxicity (proteinuria), cardiovascular toxicity (decrease in left ventricular ejection fraction, congestive heart failure), hypothyroidism, bleeding, gastrointestinal perforation, wound-healing complications, and venous thrombosis. Initial and follow-up work-up should include: home or 24-h ambulatory blood pressure monitoring; urine dipstick for proteinuria detection and estimated glomerular filtration rate determination (MDRD); TSH measurements; ECG; echocardiography if necessary. Optimal care is best achieved within a network of professionals including general practitioners, oncologists, cardiologists and nephrologists.

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