Trastuzumab therapy and new-onset hypertension in adolescents and young adults with breast cancer.

Background: Trastuzumab therapy carries a risk of acute cardiotoxicity, particularly when combined with anthracyclines. To date, no study has assessed hypertension as a potential long-term adverse effect of trastuzumab therapy in adolescent and young adult (AYA) cancer survivors.

Methods: We identified all female AYAs aged 15-39 years diagnosed with first primary invasive breast cancer between 2006 and 2020 in Kaiser Permanente Northern and Southern California, who survived at least 2 years post-diagnosis. Patients were categorized into two groups: those who received chemotherapy plus trastuzumab and those who received chemotherapy alone. We examined hypertension occurrence starting 2 years post-diagnosis, compared the 2-5-year cumulative incidence of hypertension between the trastuzumab and non-trastuzumab groups, and evaluated associated risk factors.

Results: Among 2382 female AYAs with breast cancer, 33.0% received trastuzumab. The 2-5-year cumulative incidence of hypertension did not differ between the trastuzumab (6.79%, 95% Confidence Interval [CI] 4.96-8.99%) and non-trastuzumab (7.85%, CI 6.41-9.48%) groups, p = 0.67. Trastuzumab was not associated with hypertension (hazard ratio (HR) = 1.01, CI 0.731-1.38) in multivariable analysis. Factors associated with higher hypertension included older age at diagnosis (35-39 vs. 15-34y), non-Hispanic Black or non-Hispanic Asian race/ethnicity (vs. non-Hispanic White), overweight or obesity (vs. underweight or normal weight), smoking, and endocrine therapy. History of diabetes and dyslipidemia showed borderline association with hypertension.

Conclusion: Trastuzumab was not associated with new-onset hypertension among AYA breast cancer survivors. However, sociodemographic and clinical factors significantly contributed to hypertension risk, highlighting the importance of interventions targeting modifiable risk factors.