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. Case Report: 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 μMoles/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. Conclusion: 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.