Nodular Regenerative Hyperplasia Induced by Trastuzumab Emtansine: Role of Emtansine?

Trastuzumab is a monoclonal antibody targeted against the Human Epidermal Growth Factor Receptor 2 (HER2) overexpressed in some breast cancer. This targeted therapy significantly improves the prognosis of these cancers. Recently an anti-HER2 antibodydrug conjugate was shaped in order to facilitate the targeted delivery of potent cytotoxic drug to cancer cells and to reduce resistance. This formulation, called trastuzumab emtansine (T-DM1), consists of the monoclonal antibody trastuzumab linked to a cytotoxic drug (a derivative of maytansine) via a chemical linker. Little is known about adverse reactions due to this new formulation. Herein we described the case of a woman suffering from a HER2-positive breast cancer, treated with trastuzumab for 30 months followed by T-DM1 monotherapy. After 12 months of T-DM1 treatment, a nodular regenerative hyperplasia confirmed by liver biopsy occurred. T-DM1 was stopped and medical imagery showed a resolution of the nodular regenerative hyperplasia. Unfortunately, hepatic metastasis progressed. Few cases of nodular regenerative hyperplasia induced by T-DM1 have been described so far. Further studies are needed to explore pathogenesis of nodular regenerative hyperplasia with this new antibody-drug conjugate treatment.

Metastatic castration-resistant prostate cancer: two case reports of dramatic response with abiraterone acetate in patients heavily pretreated with chemotherapy.

Metastatic castration-resistant prostate cancer (mCRPC) with visceral involvement requires new, effective and safe treatments after chemotherapy failure. The CYP17A1 inhibitor abiraterone acetate has been approved as a treatment for mCRPC, both after docetaxel chemotherapy and more recently for patients who are not responding to chemotherapy. In published studies, most patients previously treated with docetaxel had received a limited number of lines of chemotherapy and a small proportion of these patients presented with visceral metastases. We report two mCRPC patients with extensive visceral disease, who were heavily pretreated with chemotherapy. They experienced major responses to treatment with abiraterone acetate. For both patients, responses to abiraterone were noticeable within 1 month, encompassing a marked regression of visceral metastases and a decrease in prostate-specific antigen. The clinical benefit of abiraterone was maintained for at least 6 months and the treatment was well tolerated.