Spider Telangiectases and Palmar Erythema as Harbingers of Structural Liver Changes in Three Breast Cancer Patients on Ado-trastuzumab Emtansine.

We describe three patients treated with ado-trastuzumab emtansine who developed either palmar flushing or spider angiomas. We then correlate these findings with radiologic imaging results of the liver. Three consecutive referrals to dermatology for patient skin complaints while taking ado-trastuzumab emtansine were evaluated and found to have either telangiectases or palmar flushing. Two patients who did not have prominent nodularity on computed tomography of the liver underwent transient elastography. All three patients with stigmata of liver disease that developed during the course of ado-trastuzumab emtansine demonstrated parenchymal liver abnormalities. Patients presenting with spider angiomas and/or palmar flushing on adotrastuzumab emtansine should be considered for elastography studies to ensure early structural damage is not occurring. Further investigation is needed to define the precise etiology for these telangiectases and the role of elastography imaging in monitoring patients on long-term adotrastuzumab emtansine.