Risk Factor Analysis for Bevacizumab-induced Severe Hypertension in Advanced Breast Cancer Treatment

Bevacizumab (BV) is used in combination with paclitaxel to treat human epidermal growth factor receptor 2-negative advanced breast cancer. However, BV frequently causes hypertension. Because patients with advanced breast cancer already have an elevated cardiovascular risk, we investigated clinical factors associated with BV-induced severe hypertension in a real-world setting.

Patients with advanced breast cancer receiving BV with paclitaxel (n=67) were retrospectively evaluated. The primary endpoint was determination of factors for the occurrence of grade ≥3 severe hypertension, considering clinical significance. We also assessed the time to symptom onset and variation in blood pressure after treatment between specific patient groups.

Hypertension occurred in 73.1% of the patients, with grades 2 and 3 severity in 20.9% and 52.2%, respectively. Multivariate logistic regression analysis suggested that pre-existing hypertension at baseline was an independent risk factor for grade ≥3 hypertension (adjusted hazard ratio=3.12; 95% confidence interval=1.30-7.87; p=0.01), resulting in similar results in a sensitive analysis. Additionally, median time to symptom onset was 70 days (range=56-119 days) in patients with pre-existing hypertension and 175 days (147 days-not available) in patients without pre-existing hypertension (p=0.004). No significant difference was noted in the range of fluctuations in systolic and diastolic blood pressure during treatment between patients with and without pre-existing hypertension.

Pre-existing hypertension is a risk factor for BV-induced severe hypertension in patients with breast cancer.