Pulmonary arterial hypertension in breast cancer patients on HER2-targeted therapy: a review of FDA Adverse Events Reporting System data
Godsfavour Umoru, Matthew Taitano, Sarah Beshay, Polly Niravath, Sandeep Sahay
Abstract
The World Health Organization (WHO) classifies drug- and toxin-induced pulmonary arterial hypertension (D-PAH) as a form of Group 1 pulmonary hypertension. Pulmonary arterial hypertension (PAH) refers to pathological remodelling of the pulmonary vasculature, which carries a poor prognosis if left untreated [1, 2]. The incidence and prevalence of PAH observed with therapies that target human epidermal growth factor 2 (HER2) may be underreported. In 20–25% of breast cancers, the chromosomal region that contains the HER2 gene is amplified, which promotes overexpression of the HER2 receptor tyrosine kinase. Currently, post-marketing studies and case reports associating HER2-targeting agents such as trastuzumab, ado-trastuzumab emtansine (T-DM1), lapatinib and pertuzumab with PAH are rare (<1%), and only trastuzumab has a black box warning for pulmonary toxicity [3–6]. Prompt identification of D-PAH and discontinuation of offending agents is critical to improving outcomes for patients who may be receiving HER2-targeted therapies for breast tumours containing HER2 gene overexpression. This letter highlights a rare association of anti-HER2 cancer therapy with development of pulmonary arterial hypertension, based on a review of data from the FDA <https://bit.ly/2X90xDu>