Reinduction of trastuzumab after symptomatic heart failure in a patient with metastatic breast cancer

Introduction: Trastuzumab is a monoclonal antibody directed against the HER2/neu protein. It is effectively used as a therapeutic agent in the adjuvant and metastatic setting of breast cancer overexpressing the HER2/neu marker. Trastuzumab was demonstrated to be synergistic with different cytotoxic agents. A known adverse effect of trastuzumab therapy is heart failure due to cardiomyopathy. Case: We report on one patient with histologically proven Her2/neu positive liver metastases in breast cancer who has been treated after 4 cycles of adjuvant FEC 2 years ago with paclitaxel and later with vinorelbine in combination with trastuzumab. The patient was in complete remission of her liver metastases when during maintenance therapy with trastuzumab she developed symptomatic cardiac impairment with a significant decrease of LVEF (60% to 36%). Cessation of antibody therapy was required. Under treatment with an ACE inhibitor LVEF recovered to normal values. Due to recurrent liver metastases 1 year later further chemotherapy with carboplatin was started. Since metastases progressed trastuzumab was added and after 3 cycles partial remission could be demonstrated. The patient is in ongoing remission with normal LVEF for more than 6 months now. Conclusion: Even after heart failure retreatment with trastuzumab is feasible. The combination of carboplatin with trastuzumab might have synergistic effects.