Dose-reduced trastuzumab emtansine: active and safe in acute hepatic dysfunction

Area of Science:

• Oncology
• Pharmacology

Background:

• Breast cancer is a leading cause of cancer death in women globally, with metastatic disease significantly impacting survival rates.
• HER2-positive breast cancer accounts for 25% of diagnoses and has specific targeted therapies, including trastuzumab emtansine (TDM-1).
• TDM-1 improves progression-free survival in HER2-positive metastatic breast cancer but carries risks of liver dysfunction and acute liver failure.

Observation:

• A patient with progressive HER2-positive metastatic breast cancer presented with acute hepatic dysfunction after prior responses to HER2-targeted therapies.
• The patient had not previously been studied or reported for TDM-1 use in acute hepatic dysfunction.

Findings:

• Dose-reduced TDM-1 was administered safely to the patient with acute hepatic dysfunction.
• The treatment resulted in rapid biochemical, clinical, and radiological response.
• This enabled subsequent dose escalation of TDM-1, with the patient maintaining an ongoing response.

Implications:

• This case suggests that TDM-1, with dose modification, may be a viable treatment option for HER2-positive metastatic breast cancer patients experiencing acute liver dysfunction.
• Further studies are warranted to confirm the safety and efficacy of TDM-1 in this specific patient population.
• This finding could expand treatment options for HER2-positive metastatic breast cancer patients with challenging comorbidities.