case_images: PMC4376930_01
case_images: Changes in LFTs with TDM-1 treatment. Serum bilirubin (mumol/l), alanine transaminase (U/l) and alkaline phosphatase (U/l) levels are shown. The normal ranges (NR) for bilirubin, alanine transaminase and alkaline phosphatase are <17 micromol/l, <40 U/l and 24-110 U/l, respectively. Each cycle of TDM-1 treatment is shown along with its cycle number, dose and any dose reduction instituted. Day 0 represents the administration of the first cycle of TDM-1.
case_images: cro-0008-0113-g02.jpg
case_images: PMC4376930_01_cro-0008-0113-g02.jpg
case_images: F2
case_images: This was accompanied by an acute deterioration in her liver function tests (LFTs) (fig. 2). Over the next 48 h, her LFTs worsened (fig. 2). MBC). There is limited experience of TDM-1 in acute liver dysfunction, so the patient was treated with a calculated dose reduction (125 mg, 35% dose reduction) and remained as an inpatient for close observation (fig. 2, fig. 3). Magnetic resonance cholangiopancreatography (MRCP) was performed at baseline and confirmed an 87-mm metastatic deposit in segment V of the liver (fig. 3). The patient's LFTs worsened in the first 6 days after administration of her first cycle of TDM-1 (fig. 2). However, by day 6, her LFTs began to improve and this was maintained (fig. 2). Her second cycle of treatment was accompanied by a continued improvement in her LFTs and associated drop in CA15-3 (fig. 2, fig. 3). TDM-1 at a full dose (260 mg, 0% dose reduction). This was again well tolerated and both the patient's LFTs and CA15-3 continued to improve (fig. 2, fig. 3).
case_images: CA15-3 and radiological response to treatment with TDM-1. Changes in CA15-3 (U/ml) were recorded in response to treatment (A). The normal range (NR) for CA15-3 is <28 U/ml. Each cycle of TDM-1 treatment is shown along with its cycle number, dose and any dose reduction instituted. Day 0 represents the administration of the first cycle of TDM-1. MRCP was performed at baseline (B) and after administration of 3 cycles of TDM-1 (C) to monitor radiological response of the metastatic deposit (yellow arrows).
case_images: cro-0008-0113-g03.jpg
case_images: PMC4376930_01_cro-0008-0113-g03.jpg
case_images: F3
case_images: MBC). There is limited experience of TDM-1 in acute liver dysfunction, so the patient was treated with a calculated dose reduction (125 mg, 35% dose reduction) and remained as an inpatient for close observation (fig. 2, fig. 3). Magnetic resonance cholangiopancreatography (MRCP) was performed at baseline and confirmed an 87-mm metastatic deposit in segment V of the liver (fig. 3). In addition, her cancer antigen 15-3 (CA15-3) demonstrated an increase in line with disease progression both clinically and on imaging (fig. 3). In addition to her clinical and biochemical improvement, repeat MRCP after 3 cycles of treatment demonstrated radiological evidence of disease response (fig. 3).