Trastuzumab-Induced Respiratory Distress: A Case Report

Abstract

Trastuzumab is a monoclonal antibody effective in treating metastatic breast carcinomas. Cardiotoxicity is the most commonly reported adverse event occurring when used in combination with anthracycline derivatives. Even though pulmonary toxicities are uncommon, immediate withdrawal of the drug is recommended and only reinitiates after the vitals of the patient have become normal. Here, we discuss the case of an 81-year-old female patient who was treated with Injection Trastuzumab for the treatment of breast cancer with metastasis to lungs and received 6 cycles without any major complications. However, 24 h post the last dose; the patient developed a sudden onset of breathlessness and desaturation and was intubated in view of severe metabolic and respiratory acidosis. Blood investigations revealed elevated brain natriuretic peptide, aspartate transaminase, and alkaline phosphatase. Her blood and urine cultures were found to be sterile. She was managed with IV antibiotics, nebulizations, IV fluids, and other supportive medications and had improved considerably. However, on the 11th day, her condition had deteriorated and developed bradycardia. The patient could not be revived and died. Review of the patient’s medication did not reveal the presence of any other possible drugs capable of producing pulmonary toxicity. Trastuzumab should be avoided in patients with underlying respiratory or cardiac issues.

Experimental Therapeutic Evaluation of the African Vegetables (Clerodendrum Volubile Leaf and Irvingia Gabonensis Seed Extracts) in Trastuzumab-Mediated Hepato-Renal Dysfunction in Wistar Rats

“…TZM is also known to mediate deleterious effects of the renal function which may manifest as AKI and electrolyte imbalance [5,98,99]. AKI may manifest as profound increases in the serum creatinine and urea, hypomagnesemia, hypokalemia, hypophosphatemia, hypocalcemia [5,100], as well as metabolic acidosis [101]. In this study, acute TZM treatment was associated with hyponatremia, hypochloremia, metabolic acidosis, hyperuremia, and hypercreatininemia which are in line with previous studies [5,[101][102][103].…”

Technical Guidance on the Physicochemical and Functional Comparability Exercise for Trastuzumab Biosimilars

“…Trastuzumab is a humanized mAb that was designed to target HER 2 receptors which are highly expressed in a variety of tumors, including 25-30% of invasive breast carcinomas [5,6]. HER2 signaling is involved in promoting cell proliferation and cell death and overexpression of the receptor enhances cell growth, tumor survival, angiogenesis and, metastasis [7,8]. Trastuzumab binds to the extracellular domain of HER2 receptors inhibiting its tyrosine kinase-mediated intracellular cell signaling and activating antibodydependent cellular cytotoxicity [9,10].…”