Trastuzumab (Herceptin; Roche, Basel, Switzerland) has established itself in the field of breast cancer as an effective chemotherapy. It may have deleterious effects on cardiac function,1^–3 and pre-treatment cardiac assessment is recommended.1 This report details a fatal outcome using trastuzumab therapy.

A previously fit 58-year-old female, albeit with a 7-year hormone replacement therapy for osteoporosis (stopped the previous year), presented with sudden back pain and radiological evidence of L3–4 vertebral collapse. Stabilisation and biopsy confirmed metastatic moderate grade ductal carcinoma that was oestrogen receptor and epidermal growth factor receptor 2 (HER2) positive. A previously asymptomatic 4 cm breast mass was identified subsequently, but not resected.

The patient received chemotherapy with no breast tumour resection (initially six monthly cycles of 160 mg epirubicin (Pharmorubicin; Pharmacia, Uppsala, Sweden), finishing 6 months after her diagnosis. This drug may be cardiotoxic if safe dosages are exceeded, although safe dosages were prescribed without direct ill effect. …