title: Telangiectasia and Pulmonary Arterial Hypertension Following Treatment With Trastuzumab Emtansine: A Case Report.
abstract: Trastuzumab emtansine (T-DM1) is a Food and Drug Administration-approved novel agent for the treatment of HER-2 positive advanced breast cancer. We report a case of pulmonary arterial hypertension (PAH) that we attribute to the use of T-DM1. A 43-year-old woman with stage IV breast cancer presented with dyspnea on exertion. After excluding other secondary causes of pulmonary hypertension, a diagnosis of moderately severe PAH was made based on right heart catheterization. History revealed that the patient had been on T-DM1 before presentation. During T-DM1 treatment, the patient experienced hereditary hemorrhagic telangiectasia-like symptoms consisting of spider angiomata-skin lesions, epistaxis, and hematochezia, which resolved with discontinuation of T-DM1. Temporal associations of T-DM1 use with the development of PAH in the patient, and the reported association between hereditary hemorrhagic telangiectasia and PAH via genetic linkage, led us to suspect T-DM1 as the cause of PAH.
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN.
authors.forename: Younghoon
authors.initials: Y
authors.lastname: Kwon
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of Chicago, Chicago, IL.
authors.forename: Mardi
authors.initials: M
authors.lastname: Gomberg-Maitland
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN.
authors.forename: Marc
authors.initials: M
authors.lastname: Pritzker
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN. Electronic address: tthenapp@umn.edu.
authors.forename: Thenappan
authors.initials: T
authors.lastname: Thenappan
mesh_terms: D000080044:Ado-Trastuzumab Emtansine; D000328:Adult; D000798:Angiomatosis / Q000139:chemically induced / Q000473:pathology; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D004844:Epistaxis / Q000139:chemically induced; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced; D005884:Gingival Hemorrhage / Q000139:chemically induced; D006801:Humans; D006976:Hypertension, Pulmonary / Q000139:chemically induced*; D008453:Maytansine / Q000009:adverse effects / Q000031:analogs & derivatives*; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D017445:Skin Diseases, Vascular / Q000139:chemically induced / Q000473:pathology; D013684:Telangiectasis / Q000139:chemically induced*; D000068878:Trastuzumab
chemical_list: D000080044:Ado-Trastuzumab Emtansine; D061067:Antibodies, Monoclonal, Humanized; D008453:Maytansine; D018719:Erb-b2 Receptor Tyrosine Kinases; D000068878:Trastuzumab; C508053:ERBB2 protein, human
keywords: chemotherapy; oncology; pulmonary hypertension