title: Metastatic human epidermal growth factor 2 (HER2/neu) amplified breast cancer with acute fulminant hepatitis responding to trastuzumab, pertuzumab and carboplatin.
abstract: A 30-year-old woman presented to an outside hospital with pain in the right upper abdomen. Imaging revealed over 100 liver lesions, the largest measuring 74 mm×71 mm, and multiple lytic bone lesions. An outpatient liver biopsy showed a poorly differentiated adenocarcinoma favouring a breast primary. The tumour was oestrogen and progesterone receptor negative, but human epidermal growth factor 2 (HER2/neu) amplified. In her second clinic visit she had decompensated liver failure manifested by new-onset ascites and jaundice. Initially, the chemotherapy plan was for docetaxel, pertuzumab and trastuzumab, but given her severe liver dysfunction we used a combination of carboplatin, pertuzumab and trastuzumab as an inpatient. She was hospitalised for 14 days and eventually discharged with a marked improvement of her symptoms and liver tests. She subsequently completed five outpatient chemotherapy cycles. We showed that carboplatin is a possible alternative to docetaxel when severe liver dysfunction precludes docetaxel's use in combination with pertuzumab and trastuzumab.
authors.affiliation: Department of Hematology & Oncology, University of California, Los Angeles, David Geffen School of Medicine, Santa Monica, California, USA.
authors.forename: Mariela N
authors.initials: MN
authors.lastname: Macias
authors.affiliation: Department of Hematology & Oncology, University of California, Los Angeles, David Geffen School of Medicine, Santa Monica, California, USA.
authors.forename: Daniel Sanghoon
authors.initials: DS
authors.lastname: Shin
authors.affiliation: Department of Hematology & Oncology, University of California, Los Angeles, David Geffen School of Medicine, Santa Monica, California, USA.
authors.forename: Blanca
authors.initials: B
authors.lastname: Ledezma
authors.affiliation: Department of Hematology & Oncology, University of California, Los Angeles, David Geffen School of Medicine, Santa Monica, California, USA.
authors.forename: Saeed
authors.initials: S
authors.lastname: Sadeghi
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000188:drug therapy / Q000556:secondary*; D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D016190:Carboplatin / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006505:Hepatitis / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D008207:Lymphatic Metastasis; D049268:Positron-Emission Tomography; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000037:antagonists & inhibitors; D014057:Tomography, X-Ray Computed; D000068878:Trastuzumab
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D016190:Carboplatin; D018719:Erb-b2 Receptor Tyrosine Kinases; D000068878:Trastuzumab; C485206:pertuzumab