Why the study?
While interstitial lung disease is the main safety concern with trastuzumab deruxtecan, clinically relevant hepatotoxicity is rarely reported.
Does trastuzumab deruxtecan cause idiosyncratic drug-induced liver injury in patients with breast cancer?
Does trastuzumab deruxtecan cause idiosyncratic drug-induced liver injury in patients with breast cancer?
Trastuzumab deruxtecan can cause unpredictable and idiosyncratic hepatotoxicity, highlighting the need for liver function monitoring during therapy.
Refractory grade 3 hepatotoxicity may force T-DXd discontinuation; hypothesis-generating for incidence and management in HER2-positive breast cancer.
Trastuzumab deruxtecan (T-DXd) has demonstrated efficacy in HER2-positive and HER2-low breast cancer. Its main safety concern is interstitial lung disease, while clinically relevant hepatotoxicity is rarely reported. In our case report we describe a 49-year-old woman with HER2-positive advanced breast cancer that developed persistent grade 3 transaminase elevations after 2 cycles of T-DXd, refractory to corticosteroid treatment and requiring treatment discontinuation. This case underlines the unpredictable and idiosyncratic nature of T-DXd associated hepatotoxicity and the importance of liver function monitoring. Clinicians should consider DILI in patients with unexplained liver enzyme elevations during therapy. Further studies are needed to clarify mechanisms and risk factors.
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Lisanti et al. (2025) studied this question.
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