Anti-HER-2 therapy following severe trastuzumab-induced cardiac toxicity
Ibrahim Sadek1, Mark Keaton1, Nita J Maihle1
1Georgia Cancer Center, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA.
Abstract:
The human epidermal growth factor receptor 2 (HER2) is overexpressed in 25%-30% of breast cancer patients. Anti-HER2 therapies have changed the aggressive course of HER2+ breast cancer. In spite of the therapeutic benefits, their cardiotoxicities are major concerns, especially when used concurrently with anthracyclines. Here we present an elderly patient with relapsed HER2+ breast cancer. Her presentation for relapsed disease was unusual for the physical finding as well as the history of trastuzumab-induced severe cardiotoxicity while requiring additional anti-HER2 therapy. She received neoadjuvant anti-HER2 treatment for stage III breast caner. Due to severe reduction of cardiac ejection fraction (EF), she only received five doses of adjuvant transtuzumab. Unfortunately her disease relapsed one year later with chest wall lesions and a persistent low EF. We treated the patient with lapatinib combined with capecitabine which resulted rapid resolution of her chest wall lesion. More importantly, the patient had one year of disease control without deterioration in her ejection fraction. We discussed the management of recurrent HER2+ breast cancer with chest wall disease and the choice of anti-HER2 therapy in patients with a history of transtuzumab-induced cardiac dysfunction.
Insights
This case study highlights a novel treatment approach for HER2+ breast cancer relapse in patients with prior trastuzumab-induced cardiotoxicity. Lapatinib and capecitabine effectively managed chest wall lesions without worsening cardiac function.
Area of Science:
- Oncology
- Cardiology
- Pharmacology
Background:
- HER2-overexpressed breast cancer (25%-30% of cases) benefits from anti-HER2 therapies.
- Trastuzumab, a key anti-HER2 therapy, carries risks of cardiotoxicity, particularly with anthracyclines.
- Managing HER2+ breast cancer recurrence with pre-existing cardiac dysfunction presents a clinical challenge.
Purpose of the Study:
- To present a case of elderly patient with relapsed HER2+ breast cancer and severe trastuzumab-induced cardiotoxicity.
- To evaluate the efficacy and safety of lapatinib plus capecitabine in managing recurrent HER2+ breast cancer with chest wall disease and low ejection fraction.
- To discuss therapeutic strategies for HER2+ breast cancer in patients with a history of trastuzumab cardiotoxicity.
Main Methods:
- Retrospective case report of an elderly patient with relapsed HER2+ breast cancer.
- Patient had a history of severe cardiotoxicity (reduced ejection fraction) from adjuvant trastuzumab.
- Treatment involved a combination of lapatinib and capecitabine for recurrent disease.
Main Results:
- Lapatinib and capecitabine combination therapy led to rapid resolution of chest wall lesions.
- The patient achieved one year of disease control.
- Importantly, cardiac ejection fraction remained stable without further deterioration during treatment.
Conclusions:
- Lapatinib plus capecitabine is a viable and effective treatment option for HER2+ breast cancer recurrence in patients with a history of trastuzumab-induced cardiotoxicity.
- This combination offers disease control without compromising cardiac function.
- Careful selection of anti-HER2 therapy is crucial for patients with pre-existing cardiac issues.
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