Background

Trastuzumab emtansine (T-DM1) is an antibody-drug conjugate approved for use in human epidermal growth factor receptor 2 (HER2)-positive breast cancer. Case reports have suggested an association between T-DM1 and portal hypertension.

Purpose

To evaluate the association of T-DM1 therapy with spleen volume changes and portal hypertension on CT scans and clinical findings compared with lapatinib and capecitabine therapy.

Materials and Methods

Patients with HER2-positive breast cancer who were administered at least two cycles of T-DM1 or lapatinib and capecitabine (controls) in a tertiary institution from 2001 to 2020 and who underwent CT before initial treatment and at least once during treatment were retrospectively enrolled. Spleen volume changes and the signs of portal hypertension (gastroesophageal varix [GEV], spontaneous portosystemic shunt [SPSS], and ascites) were evaluated at contrast-enhanced CT. Patients were followed until treatment ended or for 2 years after the start of treatment. Spleen volume changes were measured with a deep learning algorithm and evaluated by using a linear mixed model. The incidences of splenomegaly and portal hypertension were compared between the T-DM1 and control groups by using a χ² test or Fisher exact test.

Results

The T-DM1 group included 111 patients (mean age, 54 years ± 11 [SD]; 111 women) and the control group included 122 patients (mean age, 50 years ± 9; 121 women). Spleen volume progressively increased with T-DM1 therapy but was constant in the control group (104% ± 5 vs −1% ± 6 at the 33rd treatment cycle, respectively; P < .001). Incidences of splenomegaly (46% [51 of 111] vs 3% [four of 122] of patients; P < .001), GEV (11% [12 of 111] vs 1% [one of 122] of patients; P < .001), and SPSS (27% [30 of 111] vs 1% [one of 122] of patients; P < .001) were higher in the T-DM1 group than in the control group.

Conclusion

Trastuzumab emtansine therapy was associated with noncirrhotic portal hypertension at CT, with higher incidences of splenomegaly, gastroesophageal varix, and spontaneous portosystemic shunt than those with lapatinib and capecitabine therapy.

© RSNA, 2022

Online supplemental material is available for this article.

中文翻译：

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HER2 阳性乳腺癌曲妥珠单抗 Emtansine 治疗后非肝硬化性门脉高压症通过深度学习测量的 CT 脾脏体积确定

背景

曲妥珠单抗 emtansine (T-DM1) 是一种抗体-药物偶联物，已获准用于治疗人表皮生长因子受体 2 (HER2) 阳性乳腺癌。病例报告表明 T-DM1 与门静脉高压症之间存在关联。

目的

与拉帕替尼和卡培他滨治疗相比，评估 T-DM1 治疗与 CT 扫描和临床发现的脾体积变化和门脉高压之间的关联。

材料和方法

回顾性纳入 2001 年至 2020 年在三级机构接受至少两个周期的 T-DM1 或拉帕替尼和卡培他滨（对照）治疗并且在初始治疗前接受 CT 且治疗期间至少接受一次 CT 的 HER2 阳性乳腺癌患者。在对比增强 CT 上评估了脾脏体积变化和门脉高压征象（胃食管静脉曲张 [GEV]、自发性门体分流术 [SPSS] 和腹水）。随访患者直至治疗结束或治疗开始后 2 年。使用深度学习算法测量脾脏体积变化，并使用线性混合模型进行评估。采用χ ²检验或Fisher精确检验比较T-DM1组和对照组脾肿大和门脉高压的发生率。

结果

T-DM1 组包括 111 名患者（平均年龄，54 岁±11 [SD]；111 名女性），对照组包括 122 名患者（平均年龄，50 岁±9；121 名女性）。脾脏体积随着 T-DM1 治疗逐渐增加，但在对照组中保持不变（在第 33 个治疗周期分别为 104% ± 5 和 -1% ± 6；P < .001）。脾肿大的发生率（46% [111 名中的 51 名] vs 3% [122 名中的 4 名] 患者；P < .001），GEV（11% [111 名中的 12 名] vs 1% [122 名患者中的一名]；P < .001）和 SPSS（27% [111 名患者中的 30 名] vs 1% [122 名患者中的一名]；P < .001）在 T-DM1 组中高于对照组。

结论

曲妥珠单抗 emtansine 治疗与 CT 上的非肝硬化性门静脉高压相关，脾肿大、胃食管静脉曲张和自发性门体分流的发生率高于拉帕替尼和卡培他滨治疗。

©北美放射学会，2022

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