title: Trastuzumab plus estrogen suppression as salvage treatment in a case of liver failure due to metastatic breast cancer.
abstract: BACKGROUND
  Liver failure associated with metastatic breast cancer is a short-term survival condition in which standard chemotherapy is almost always contraindicated.
  
  
  METHODS
  A 45-year-old premenopausal woman with jaundice, due to extensive metastatic liver involvement from infiltrating ductal carcinoma of the right breast, with positive hormonal receptors (ER 70%, PgR 80%), a high proliferative index (Ki-67 60%) and HER2 overexpressed (immunohistochemical HercepTest 3+) was referred. Metastases were also present in the lymph nodes of the homolateral axilla and in both lungs (T2N2M1). Liver function indices were quite altered, in particular: total bilirubin 12.32 mg/dl (direct 11.49 mg/dl), ammonemia 270 microMoles/l and albumin 2.9 g/dl. Treatment consisted of trastuzumab at a loading dose of 4 mg/kg, followed by weekly doses of 2 mg/kg, Leuprolide at 3.75 mg intramuscularly monthly and Tamoxifen 20 mg daily.
  
  
  RESULTS
  The patient presented a rapid and progressive improvement in her clinical conditions and in liver tests. The jaundice was resolved after 1.5 months and after 4 months she had normal liver function tests and an objective partial response was evident. The treatment was optimally tolerated. At this point Taxol, at a dose of 80 mg/m2 weekly, was added. After 10 months, the patient was well with a very important objective remission of all the tumor masses, and is continuing with the combined treatment.
  
  
  CONCLUSIONS
  Trastuzumab plus estrogen suppression can be an effective salvage therapy in patients with liver failure due to metastatic HER2 and ER/PgR-positive breast cancer.
authors.affiliation: Medical Oncology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy. martoni@aosp.bo.it
authors.forename: Andrea A
authors.initials: AA
authors.lastname: Martoni
authors.forename: Alessandra
authors.initials: A
authors.lastname: Bernardi
authors.forename: Sara
authors.initials: S
authors.lastname: Quercia
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology*; D020847:Estrogen Receptor Modulators / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D017093:Liver Failure / Q000209:etiology*; D008875:Middle Aged; D009362:Neoplasm Metastasis; D016879:Salvage Therapy; D000068878:Trastuzumab; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D020847:Estrogen Receptor Modulators; D000068878:Trastuzumab