TKI Hypertension Biomarker — SCE Medical Oncology MCQ

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HardImmunotherapy & Targeted TherapyTKI Hypertension BiomarkerSCE Medical Oncology

A 60-year-old man with metastatic RCC develops hand-foot skin reaction on cabozantinib. He is also hypertensive and has proteinuria. These are all class effects of multi-kinase VEGFR-TKIs. Which TKI adverse effect paradoxically predicts better tumour outcomes?

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Correct answer: B — New hypertension reflecting VEGF-pathway target engagement

Treatment-emergent hypertension is a pharmacodynamic consequence of effective VEGF-pathway inhibition and has correlated with improved outcomes in VEGFR-TKI cohorts. New proteinuria reflecting on-target VEGF-pathway inhibition: proteinuria is an on-target toxicity but is not the best-established efficacy-associated marker asked here. New hypothyroidism reflecting on-target VEGF-pathway inhibition: hypothyroidism has observational associations but hypertension is the classic pharmacodynamic correlate. New palmar-plantar reaction reflecting on-target VEGF-pathway inhibition: hand-foot reaction is exposure related but not a direct blood-pressure pharmacodynamic marker. New diarrhoea reflecting on-target VEGF-pathway inhibition: diarrhoea is nonspecific and does not serve as the recognised on-target efficacy correlate.

Reference: Treatment-induced hypertension as a biomarker in metastatic renal-cell carcinoma (Published May 2019): https://pmc.ncbi.nlm.nih.gov/articles/PMC6555944/; CABOMETYX UK summary of product characteristics (Current UK SmPC, accessed July 2026): https://www.medicines.org.uk/emc/product/4331/smpc