Trastuzumab-related palmar plantar erythrodysaesthesia

摘要

Sir - Trastuzumab (Herceptin~R) is a licensed monoclonal antibody used as adjuvant therapy for breast cancer patients [1] where HER2 over-expression or gene amplification can be demonstrated. This case describes the occurrence of palmar plantar erythrodysaesthesia (PPE) as an extremely rare drug-related complication.A 66-year-old postmenopausal woman presented with a 5 x 3 cm left breast mass. She had a history of hypertension and hypercholesterolaemia for which she was on amlodipine and atorvastatin (both more than 5 years). A mammogram, ultrasound and biopsy revealed two discrete oestrogen receptor- and progesterone receptor-positive lesions, one being HER2 1+ on immunohisto-chemistry and another HER2 3+. Fine needle aspiration of a single palpable axillary lymph node confirmed regional spread. Neoadjuvant chemotherapy was offered, but was declined by the patient in favour of endocrine therapy and letrozole was initiated instead. The patient proceeded to mastectomy and axillary node clearance. Histopathology revealed two separate grade 3 infiltrating ductal carcinomas with clear surgical margins, both associated with lymphovascular space invasion with six of 12 lymph nodes involved with malignancy. Adjuvant adriamycin and cyclophosphamide chemotherapy was delivered followed by adjuvant radiotherapy, exemestane and trastuzumab, at a loading dose of 8 mg/kg followed by 6 mg/kg every 3 weeks.