Community-Based Cardio-Oncology Model for Hypertension Management in Gynecologic Oncology Patients on VEGF Inhibitors.

BACKGROUND: Vascular endothelial growth factor inhibitors (VEGFi) play an integral role in the treatment of gynecologic malignancies. However, a common limitation to treatment is hypertension, a known adverse effect of VEGFi. Patients requiring prolonged treatment with VEGFi carry a higher cardiovascular risk. PROJECT RATIONALE: There is no standardized, prospective pathway to manage VEGFi-associated hypertension and keep cancer therapy on schedule, particularly in gynecologic oncology patients with prolonged therapy and comorbidities. PROJECT SUMMARY: We implemented a prospective, nonrandomized, and protocol-driven pilot quality improvement study enrolling 22 patients with gynecologic malignancies who were initiating or receiving VEGFi therapy. Management included mechanism-based antihypertensive therapy, grant-funded home blood pressure monitoring, structured education, and multidisciplinary follow-up. No patient had hypertension-related interruptions to VEGFi therapy, and most achieved control with 1 to 2 agents. TAKE-HOME MESSAGE: A multidisciplinary cardio-oncology pathway successfully prevented hypertension-related VEGFi treatment interruptions while emphasizing the importance of addressing broader cardiovascular comorbidities beyond hypertension alone.