maytansine and Telangiectasis

Breast cancer is the most common cancer in women. Human epidermal growth factor receptor 2 (HER2) positivity rate is 20% and generally has a poor prognosis. Ado-trastuzumab emtansine (T-DM1) is an antibody-drug conjugate consisting of HER2 target monoclonal antibody trastuzumab and microtubule inhibitor emtansine. The most common side effects are fatigue, diarrhea, anemia, and it is generally a safe and tolerable agent.. In our case, we reported our patient who developed mucosal and cutaneous telangiectasia after T-DM1 treatment and who had a complete response in metastases after skin lesions.. While no side effects were observed during the use of T-DM1 for HER2 positive disease, nose bleeding and spider telangiectasia on the skin developed in the 9th month of the treatment. In these lesions, which did not require any treatment, no regression was observed during T-DM1 treatment.. We think that T-DM1, which was detected with a low incidence of skin toxicity in studies, may form telangiectatic lesions due to vascular dilatation through emtansine, and therefore care should be taken in the treatment of T-DM1.

Topics: Ado-Trastuzumab Emtansine; Breast Neoplasms; Female; Humans; Maytansine; Receptor, ErbB-2; Telangiectasis; Trastuzumab

Topics: Ado-Trastuzumab Emtansine; Adrenergic beta-Antagonists; Antineoplastic Agents, Immunological; Female; Hemostatic Disorders; Humans; Maytansine; Middle Aged; Propranolol; Skin; Telangiectasis; Trastuzumab; Treatment Outcome

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.

Topics: Ado-Trastuzumab Emtansine; Adult; Angiomatosis; Antibodies, Monoclonal, Humanized; Breast Neoplasms; Epistaxis; Female; Gastrointestinal Hemorrhage; Gingival Hemorrhage; Humans; Hypertension, Pulmonary; Maytansine; Receptor, ErbB-2; Skin Diseases, Vascular; Telangiectasis; Trastuzumab

Topics: Ado-Trastuzumab Emtansine; Antibodies, Monoclonal, Humanized; Antineoplastic Agents; Breast Neoplasms; Clinical Trials, Phase III as Topic; Female; Hemorrhage; Humans; Maytansine; Telangiectasis; Trastuzumab

Treatment of HER2-positive metastatic breast cancer with ado-trastuzumab emtansine (T-DM1), a novel antibody-drug conjugate, has resulted in both improved progression-free and overall survival. Recognition and treatment of diverse adverse events related to T-DM1 is critical for safety and tolerability. The most frequent adverse events with T-DM1 include fatigue, diarrhea, anemia, elevated transaminases, and mild-to-moderate hemorrhagic events, which are thought to be related to induced thrombocytopenia. Here, we present five case series of cutaneous and mucosal telangiectasias, definitely related to T-DM1. The development of telangiectasias represents a newly recognized adverse effect of T-DM1. We provide description and timing of the telangiectasias and review the mechanisms that may explain the formation of these vascular lesions in association with T-DM1. Further, we describe associated bleeding events and propose that induced telangiectasias could represent an additional cause of T-DM1-associated hemorrhage.

Topics: Ado-Trastuzumab Emtansine; Adult; Aged; Antibodies, Monoclonal, Humanized; Antineoplastic Agents; Breast Neoplasms; Female; Humans; Maytansine; Middle Aged; Neoplasm Metastasis; Skin; Telangiectasis; Trastuzumab