How do you treat metastatic HER2 positive breast cancer in a patient with hepatic visceral crisis?

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 plus car...

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...