Ado-trastuzumab emtansine-associated telangiectasias in metastatic breast cancer: a case series
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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.
KeywordsAdo-trastuzumab emtansine Breast cancer Hemorrhage T-DM1 Telangiectasia Thrombocytopenia Spider nevus
Hereditary hemorrhagic telangiectasia
Immune thrombocytopenia purpura
Upper limit of normal
We express our gratitude to the patients and staff at Memorial Sloan Kettering Cancer Center and the Cancer University Institute. REN was supported by a Medical Scientist Training Program grant from the National Institute of General Medical Sciences of the National Institutes of Health under award number T32GM007739 to the Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional MD PhD Program.
Conflict of interest
VS, REN, KS, HR, and JPD declare that they have no conflicts of interest. SM received funding from Genentech for research. MEL has a speaking, consultant, or advisory role with Advancell, AstraZeneca, Aveo, Bayer, Berg Pharma, Bristol-Myers Squibb, Galderma, Genentech, Genzyme, GlaxoSmithKline, Helsinn, Imclone, Lilly, Lindi Skin, Merck, Novocure, Onyx, Pfizer, Roche, Sandoz, Sanofi Aventis, and Wyeth. The authors declare no financial relationship with a sponsoring institution.
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