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53 Discontinuation of bevacizumab may be applicable if systolic BP is >200 mmHg or if diastolic BP is >100 mmHg, or in cases of hypertensive crisis. CHF Approximately 2%�C4% of patients treated with bevacizumab will develop CHF.1 Predisposing factors include previous therapy with cardiotoxic chemotherapy drugs, such as anthracyclines24 and capecitabine,10 as well as irradiation to the mediastinum.1 The main mechanism responsible for bevacizumab-associated CHF is suggested to be uncontrolled HTN, leading to LV hypertrophy.54 On the other hand, animal studies have demonstrated that normal cardiac growth and preserved contractile function are associated with enhanced buy Quisinostat coronary angiogenesis; thus, disruption of coordinated tissue growth and angiogenesis in the heart, induced by bevacizumab, contributes to progression from adaptive cardiac hypertrophy to heart failure (HF).55 Furthermore, angiogenesis plays a key role in the normal adaptive response to pressure overload. A study that ankyrin has utilized strategies mimicking the mechanism of bevacizumab have shown that pressure overload resulted in a reduction of contractile dysfunction and eventually decompensated HF.54 CHF has mainly been reported in clinical trials assessing the efficacy and toxicity of bevacizumab in breast cancer patients. This might be related to the fact that the majority of patients with metastatic breast cancer have been previously treated with cardiotoxic drugs, such as anthracyclines. In a Phase III breast cancer trial, anthracycline treatment preceded all cases of cardiomyopathy and HF (2.6% of patients).56 In another study,10 LVD was reported in find protocol or lung cancer trials evaluating bevacizumab.7,9,57 In a recent retrospective study that included 6,937 patients aged ��65 years with CRC, no association between bevacizumab and CHF or cardiac death was observed.58 These results suggest that the main predisposing factor for the development of CHF in patients receiving bevacizumab is not advanced age, but rather previous therapy with cardiotoxic drugs. Cancer patients on bevacizumab therapy who develop HF should be treated according to guidelines proposed by the ESC and ESMO.50,59 Patients developing asymptomatic LVEF dysfunction of