1836 Circulation November 10, 2015 appear any time during therapy (especially when VEGF inhibitors are administered), and likely contributes to left ventricular (LV) injury, LV systolic dysfunction (LVSD), and HF. Incidence varies widely in clinical trials, likely as a result of differences in the patient population being studied and the methodology of collecting adverse event information. An 11% to 16% incidence of hypertension with sunitinib was reported in 2 trials, 5, 13, 14 but the incidence was> 50% when examined in real-world patients in other studies. 15, 16 Combined treatment with bevacizumab and sunitinib or sorafenib increases the risk of hypertension to 67% and 92%, respectively. 17

Cancer induces a prothrombotic state, especially in patients with metastatic disease, and the risk of thrombosis is increased in patients with known risk factors such as advanced age, immobility, and infection. Chemotherapy can further increase the risk by damaging the endothelium and the vessel walls, decreasing coagulation inhibitors, and enhancing platelet activation. 5 Angiogenesis inhibitors such as bevacizumab, 18 thalidomide, and lenalidomide inhibit the VEGF-induced association between cadherin 5, CD31, and β-catenin and are known to be associated with thrombosis5, 12 (Table 1). The incidence of chemotherapy-associated myocardial ischemia is not known because it has usually been based