Life-threatening interstitial lung disease associated with trastuzumab: case report

Abstract

A female patient with HER2 positive, metastatic breast cancer presented with pulmonary infiltrates, and a plural effusion dyspnoea after several months of trastuzumab treatment. She had been treated without complications with six courses of docetaxel and trastuzumab in combination with dexamethasone with partial remission of disease. Malignancy, infection and cardiomyopathy were excluded as causes of dyspnoea. Pleural and broncheoalveolar fluid analyses (BAL) showed eosinophils. A diagnosis of trastuzumab-induced pneumonitis was made. After treatment with steroids there was gradual clinical improvement and disappearance of infiltrates. Although a causative association between trastuzumab and this patient's pulmonary syndrome was not proven, the potential for this toxicity should be considered.

Pulmonary toxicities of biologics: a review

“…Altogether, the reports of apparent trastuzumab-related pulmonary interstitial disease in B-31, N9831, and four other reports [55,[64][65][66] are highly suggestive that this syndrome is a rare, but real, complication of this therapy. In one case, the patient subsequently developed Guillian-Barre syndrome [66].…”

“…In one case, the patient subsequently developed Guillian-Barre syndrome [66]. Clinicians should be aware of it and be prepared to respond appropriately, including discontinuation of further treatment or cautious coadministration with corticosteroids [64].…”

Interstitial lung disease associated with trastuzumab monotherapy: A report of 3 cases

“…Those case reports mostly concluded that paclitaxel or docetaxel, rather than trastuzumab, was responsible for the development of ILD, as ILD is a well-known complication of taxanes. However, according to our literature survey, there have been 4 English-language case reports of trastuzumab monotherapy-associated ILD (10)(11)(12)(13). Those cases and the 3 cases presented herein are summarized in Table I.…”

Infectious Complications Associated with Monoclonal Antibodies and Related Small Molecules

“…Infectious complications are generally mild, such as upper respiratory tract infections and UTIs, and no opportunistic infections have been reported in the literature (3,176,183), although an increase in the number of overall infections and degree of febrile neutropenia has been reported for combinations with certain chemotherapeutic agents, such as doxorubicin plus cyclophosphamide followed by paclitaxel plus trastuzumab (Herceptin package insert). Life-threatening interstitial lung disease has been reported, although it was not clearly identified as infectious in nature (129). Interestingly, ErbB2 activation has been implicated in demyelination induced by Mycobacterium leprae, and ErbB2 blockade has been shown to abrogate M. leprae-induced myelin damage in both in vitro and in vivo models (172).…”