Trastuzumab treatment of invasive breast ductal carcinoma induces severe edema: a case report

BACKGROUND: Trastuzumab, a monoclonal antibody which binds to the extracellular domain of human epidermal growth factor receptor 2 (HER2), is the first biological drug approved for the treatment of HER2-positive breast cancer. However, trastuzumab exhibits a series of clinical adverse effects, including cardiac toxicity, nerve damage, abnormal liver function, thrombocytopenia, etc. CASE DESCRIPTION: We report a case of a 46-year-old female patient with invasive breast ductal carcinoma (classified as Stage 2B) who developed a rare severe edema in neck, face, chest, abdomen and both upper limbs after a single dose trastuzumab treatment. The patient (~60 kg weight) was administered with trastuzumab (420 mg) with an infusion time of 2 hours. The most severe edema symptom was observed in patient’s hands, in which the epidermis was markedly transparent and tight. One month after trastuzumab administration, the patient was administered with methylprednisone (80 mg per day) for 5 days. The edema in patient’s neck, face and both upper limbs was mildly reduced though the CT image showed no significant reduction of edema. CONCLUSIONS: Trastuzumab treatment for breast cancer patients, particularly those who have an allergic constitution, may have an adverse effect to develop severe edema, and treatment with methylprednisone at early stage can reduce such adverse reaction.