All anti-vascular endothelial growth factor drugs can induce 'pre-eclampsia-like syndrome': a RARe study

Area of Science:

• Oncology
• Nephrology
• Vascular Biology

Background:

• Vascular endothelial growth factor (VEGF) targeted therapies improve metastatic cancer survival but can cause renal side effects.
• Underrecognized renal complications include proteinuria, hypertension, and renal failure.
• The French RARe registry specifically investigates renal complications in cancer patients treated with anti-VEGF drugs.

Purpose of the Study:

• To analyze renal biopsy findings in cancer patients experiencing major renal side effects during anti-VEGF therapy.
• To correlate histological findings with clinical and biological data.
• To emphasize the importance of multidisciplinary management.

Main Methods:

• Data collection from the French RARe (Reins sous traitement Anti-VEGF Registre) study.
• Analysis of 22 renal biopsies from patients with cancer undergoing anti-VEGF treatment.
• Assessment of clinical parameters (hypertension, proteinuria, creatinine) and histological features (thrombotic microangiopathy, acute tubular necrosis).

Main Results:

• Renal biopsies revealed significant lesions, with 21/22 patients having hypertension and a mean proteinuria of 2.97 g/day.
• Thrombotic microangiopathy (TMA) was prevalent (21/22), often associated with acute tubular necrosis (ATN).
• Histological TMA severity exceeded biological indicators; ATN correlated with higher creatinine levels. Key proteins (nephrin, podocin, synaptopodin) and VEGF were downregulated.

Conclusions:

• Regular clinical and biological monitoring for renal dysfunction is vital during anti-VEGF cancer therapy.
• Early detection and intervention are crucial for managing renal side effects.
• Renal biopsy aids in assessing lesion severity, guiding treatment decisions in a multidisciplinary setting involving oncologists and nephrologists.