Design: Systematic review and meta-analysis of randomised trials
Population: 4 trials, 1,872 patients with gastrointestinal cancers
Primary outcome: Hypertension, proteinuria, bleeding, VTE and hand-foot skin reaction
Effect: Grade 3+ hypertension RR 9.01 (4.67-17.40); proteinuria RR 1.89 (1.30-2.74)

Fruquintinib is an oral VEGF receptor inhibitor, which the authors describe as approved for previously treated metastatic colorectal cancer (approval varies by country); it is being tested in other gastrointestinal cancers. This meta-analysis pooled four randomised trials with 1,872 patients.

Fruquintinib increased grade 3 or higher hypertension about ninefold (RR 9.01, 95% CI 4.67 to 17.40) and any-grade proteinuria (RR 1.89, 1.30 to 2.74). Severe hand-foot skin reaction was also much more common. Severe bleeding was uncommon and not significantly increased; venous thromboembolism estimates were imprecise.

The pattern matches the class: VEGF inhibition raises blood pressure and damages the glomerular filtration barrier. Nephrologists increasingly see these patients, and simple baseline and serial checks catch both problems early.

Measure blood pressure and urine albumin-creatinine ratio before starting fruquintinib.
Control blood pressure before treatment and check it regularly during the first cycles.
Consider an ACE inhibitor or angiotensin receptor blocker when hypertension and proteinuria occur together.
Discuss dose interruption with the oncology team for severe hypertension or heavy proteinuria.

Why it matters

VEGF inhibitor use is widening, and hypertension and proteinuria are the kidney problems most likely to interrupt cancer treatment.

The statistics, in plain English

A risk ratio of 9.01 for severe hypertension is large, but the wide confidence interval (4.67 to 17.40) reflects relatively few events. The absolute rates are not given in the abstract.