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Case report
Acute eosinophilic pneumonia: a fatal reaction to ado-trastuzumab
  1. Daniel LaMorte1,2,
  2. Daniel Desmond3,
  3. John Ellis4 and
  4. Stanley Lipkowitz5
  1. 1Department of Internal Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
  2. 2Department of Internal Medicine, Naval Medical Center Portsmouth, Portsmouth, Virginia, USA
  3. 3Department of Oncology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
  4. 4Department of Pulmonology and Critical Care, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
  5. 5Women's Malignancies Branch, Center for Cancer Research, National Cancer Institute, Bethesda, Maryland, USA
  1. Correspondence to Dr Daniel LaMorte; lamortedaniel{at}gmail.com

Abstract

Ado-trastuzumab emtansine (T-DM1) is a monoclonal antibody drug conjugate approved for the treatment of HER2-positive breast cancers. Presented here is a case report of a patient who developed fatal pulmonary toxicity in the form of acute eosinophilic pneumonia while undergoing treatment with T-DM1. Prior to beginning T-DM1 therapy, this patient had been treated with two HER2-targeted agents (trastuzumab, pertuzumab) per National Comprehensive Cancer Network (NCCN) guidelines. This case represents a novel presentation of toxicity associated with T-DM1 while perhaps demonstrating additive toxicity associated with multiple lines of HER2 targeted therapies.

  • breast cancer
  • chemotherapy
  • interstitial lung disease
  • pneumonia (respiratory medicine)
  • unwanted effects / adverse reactions

https://doi.org/10.1136/bcr-2021-243881

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    Footnotes

    • Contributors DL: Walter Reed National Military Medical Center, Department of Internal Medicine—personally cared for patient. Acquisition of data regarding patient’s status and workup. Literature review. Primary author in composing text of manuscript. DD: Walter Reed National Military Medical Center, Department of Oncology—personally cared for patient. Literature review and interpretation of data, particularly with regard to breast cancer treatments and their adverse reactions. Made significant edits and rewrites to text of manuscript. JE: Walter Reed National Military Medical Center, Department of Oncology—acquisition of data on patient and her workup. Literature review and interpretation of data, particularly with regard to acute eosinophilic pneumonia. Composed bulk of the text regarding diagnosis/treatment of acute eosinophilic pneumonia. SL: PhD, Center for Cancer Research, National Cancer Institute, Department of Oncology—senior adviser to project. Literature review and data interpretation. Made final round of edits to manuscript prior to submission.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.