Abstract
Ado- Trastuzumab-Emtansine is approved by EMA and FDA for treatment of HER-2-positive metastatic breast cancer. The drug combines the cytotoxic activity of emtansine with trastuzumab [1,2,3]. Here we are describing 50- year old woman with 3-ple positive left breast cancer with metastasis to left axillary lymph nodes treated with the drug. The patient had normal liver and spleen structure on CT of the abdomen with I.V. contrast, along with a normal liver function test. However she did have a mild elevation of her indirect bilirubin after the initiation of the drug. Despite the normal liver and spleen and absence of Cirrhosis the patient developed drug induced spider angiomas on the upper chest, upper back, shoulders along with palmar erythema. The association of the Ado-Trastuzumab-Emtansine with spider angiomas and palmar erythema in those with normal liver and spleen function, with only a mild elevation of indirect bilirubin is discussed in the article [1].
Highlights
Ado- Trastuzumab-Emtansine is approved by EMA and FDA for treatment of HER-2-positive metastatic breast cancer
The drug combines the cytotoxic activity of emtansine with trastuzumab [1,2,3]
The patient had normal liver and spleen structure on CT of the abdomen with I.V. contrast, along with a normal liver function test. She did have a mild elevation of her indirect bilirubin after the initiation of the drug
Summary
Ado-Trastuzumab- Emtansin/T-DM1 is an antibody-drug conjugate that combines the antitumor properties of trastuzumab against HER-2- with the cytotoxic activity of emtansine, a microtubule-inhibitory agent (2,3). Since transaminitis is one of the major side effects of T-DM1 and spider nevi are seen in other hepatic diseases, they postulate that liver injury may play a role on its development. They try to relate the mechanism of development of telangiectasia in hereditary hemorrhagic telangiectasia (HHT) to disruption of cytoskeletal microtubules with the cytotoxic activity of emtansine [1,4]. Her EGD in result did not show any telangiectatic changes in the upper Gastrointestinal tract We described this case to alert the physicians that the spider angiomas and palmar erythema can be side effect of the Ado-Trastuzumab- Emtansin unrelated to liver damage. Mild elevation of indirect bilirubin was probably related to the chemotherapeutic drug-T- DM-1
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