Severe thrombocytopenia induced by trastuzumab rechallenge: a case report and literature review.

Abstract

WHAT IS KNOWN AND OBJECTIVE:

Trastuzumab can significantly prolong the survival of patients with human epidermal growth factor receptor-2 (HER-2)-positive breast cancer. Trastuzumab-induced thrombocytopenia is a rare adverse effect. There have been no reports of acute, grade 4 thrombocytopenia after weekly trastuzumab therapy. The study reports a case of a breast cancer patient with severe thrombocytopenia due to trastuzumab infusion (8 mg/kg). Moreover, the patient experienced recurrence of severe thrombocytopenia after receiving weekly trastuzumab therapy (4 mg/kg).

CASE SUMMARY:

A 52-year-old woman with HER-2-positive breast cancer developed diffuse petechial haemorrhages and ecchymosis on the lower limbs and gingival bleeding within 24 hours of trastuzumab infusion (8 mg/kg). She was confirmed to have severe thrombocytopenia, which quickly recovered after corticosteroid therapy and platelet transfusion. When her platelet count recovered, we attempted weekly trastuzumab therapy (4 mg/kg); however, thrombocytopenia recurred within 24 hours. Thus, we did not attempt further treatment with trastuzumab.

WHAT IS NEW AND CONCLUSION:

We are the first to attempt weekly trastuzumab therapy after thrombocytopenia induced by its initial administration. Reducing the trastuzumab dose did not prevent trastuzumab-induced thrombocytopenia. Unlike other reports with administration of high-dose corticosteroid, we found that a standard dose of corticosteroid combined with platelet transfusion was effective in treating trastuzumab-induced thrombocytopenia.

• Authors: Xin Wang, Xiaoli Zhu, Jieya Zou, Xia Zhang, Xianshu Kong, Jianyun Nie
• Journal: Journal of clinical pharmacy and therapeutics (J Clin Pharm Ther) Vol. 46 Issue 4 Pg. 1173-1177 (Aug 2021) ISSN: 1365-2710 [Electronic] England
• PMID: 33735519 (Publication Type: Case Reports)
• Copyright: © 2021 John Wiley & Sons Ltd.

Chemical References

• Antineoplastic Agents, Immunological
• Trastuzumab

Topics

• Antineoplastic Agents, Immunological (adverse effects, therapeutic use)
• Breast Neoplasms (drug therapy)
• Female
• Humans
• Middle Aged
• Thrombocytopenia (chemically induced)
• Trastuzumab (adverse effects, therapeutic use)