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Trastuzumab delivery and changes in left ventricular ejection fraction (LVEF) in 110 patients receiving adjuvant trastuzumab in routine practice are investigated. The potential impact of new, less stringent UK cardiac monitoring guidelines is examined. 86 patients (78%) completed trastuzumab on schedule. 11 (10%) completed treatment despite delay(s) to allow LVEF recovery, 7 (6%) discontinued trastuzumab because of insufficient LVEF recovery, 2 (2%) of whom developed symptomatic cardiotoxicity. 6 (5%) discontinued trastuzumab for non-cardiac reasons. With the newer guidelines, the value of LVEF lower limit of normal is important in determining the proportion of patients who require angiotensin-converting enzyme inhibitors (ACEIs) and cardiology referral: up to 100% could potentially complete trastuzumab on schedule with up to 60% receiving ACEIs and 25% requiring cardiology referral. Adjuvant trastuzumab was well tolerated overall. The new guidelines potentially allow more patients to complete trastuzumab on schedule but require higher levels of cardiological intervention.

SUMMARY Three patients with cardiac tamponade secondary to disseminated breast carcinoma were treated by pericardiocentesis followed by systemic cytotoxic chemotherapy. This approach controlled pericardial effusion in all the patients and extended their survival.

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SUMMARYThis is a case report on the use of systemic therapy to successfully regress choroidal metastases due to breast cancer. The choroid is the commonest site for intraocular metastatic disease. Breast and lung cancer are frequently the primary malignancies. Traditionally, choroidal metastases are treated with local therapy to the eye including using either external beam radiotherapy, brachytherapy or, recently, with photodynamic therapy. We report on the impressive results obtained with the use of palliative paclitaxel chemotherapy and trastuzumab after only 8 weeks. Funduscopic images and ultrasound findings support this. BACKGROUND