How do you treat metastatic HER2 positive breast cancer in a patient with hepatic visceral crisis?
The patient has extensive liver metastases and a high bilirubin. She has not received any prior systemic therapy in the metastatic setting.
Answer from: Medical Oncologist at Academic Institution
I recently had a patient who presented with de novo HER2+ metastatic breast cancer and acute liver failure secondary to extensive liver metastasis. Her AST/ALT were > 5 times ULN and T. Bili was > 6. Docetaxel is not an option in this setting therefore, I opted to treat her with gemcitabine pl...
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Answer from: Medical Oncologist at Academic Institution
Agree that the challenge here is finding a chemotherapy backbone that doesn't rely on hepatic clearance (or can be given at a reduced dose safely) to combine with dual HER2 targeted therapy. Gemcitabine, platinums, and potentially capecitabine (depending on the degree of liver dysfunction) are all f...