Trastuzumab emtansine associated nodular regenerative hyperplasia: A case report and review of literature
Section snippets
Background
Trastuzumab emtansine (T-DM1) is a drug-antibody conjugate linking trastuzumab to emtansine by non-reducible thioester linker, 4-[N-maleimidomethyl] cyclohexane-1 carboxylate (MCC) [1]. Trastuzumab is a monoclonal antibody targeting the human epidermal growth factor receptor-2 (HER2) and emtansine (DM-1), a maytansine derivative, and is a cytotoxic agent that acts by microtubule inhibition. The drug-antibody conjugate binds the HER2 receptor and becomes internalized whereby DM-1 can then
Case presentation
A 73-year-old female was diagnosed with locally advanced estrogen receptor (ER) positive, progesterone receptor (PR) negative, HER 2-positive (HER 2 FISH 4.2), stage IIIA (T3N2) left breast CA in January 2010. She received 6 cycles of neoadjuvant Docetaxel, Carboplatin, Herceptin (TCH) and underwent modified radical mastectomy. Following surgery, she completed 52 weeks of adjuvant Herceptin and was placed on adjuvant endocrine therapy with anastrazole. She was found to have new mediastinal and
Discussion
T-DM1 is a drug-antibody conjugate consisting of trastuzumab, emtansine, and a thioester linker that has shown very promising activity in advanced HER 2-positive breast cancer. T-DM1 is an appealing treatment option for metastatic HER 2-positive breast cancer as it is devoid of toxicities associated with conventional cytotoxic agents.
Transaminase elevations and thrombocytopenia with T-DM1 are well known with grade 3 and 4 events in acceptable ranges for treatment of advanced breast cancer. Mild
Consent
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor of this journal.
Competing interests
The authors declare that they have no competing financial interests.
Authors' contributions
LHP, ID, RMA, JCO, QJK, PS obtained the data
LHP, ID, RMA, JCO, QJK, PS documented the case and
LHP, ID, RMA, JCO, QJK, PS performed the literature search
LHP, ID, RMA, JCO, QJK, PS contributed to the writing process
LHP, ID, RMA, JCO, QJK, PS critically reviewed the data
LHP, ID, RMA, JCO, QJK, PS contributed to the writing process
All authors read and approved the final manuscript.
Acknowledgments
None.
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