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Various toxicities: case report An approximately 39-year-old woman developed grade 1 neutropenia and allergic reaction manifesting as bronchospasm, headache and dyspnoea during treatment with docetaxel, and developed acquired drug resistance during treatment with trastuzumab for a poorly differentiated human epidermal growth factor receptor 2 (HER2)-positive breast cancer [not all routes stated; frequencies, durations of treatments to reactions onsets and outcomes not stated]. The woman, at the age of 36, was diagnosed with breast cancer in 2013. She did not have any other relevant medical history. She received neoadjuvant 6FAC chemotherapy included fluorouracil, doxorubicin [adriamycin] and cyclophosphamide [cytoxan] for 6 months. Thereafter, she had undergone partial mastectomy and axillary dissection. Subsequently, she received adjuvant radiotherapy for almost 2 months and SC trastuzumab 600mg therapy. She was followed-up for the next 9 months and during this period she remained asymptomatic. Thirty months after the diagnosis, approximately at the age of 39, she presented with a right supraclavicular nodule, erythema and thickening of the skin over the right breast and superior portion of the trunk, and severe inflammatory breast cancer antigen (BCA) component. Based on further investigations, she was diagnosed with poorly differentiated HER2-positive breast cancer. Therefore, she was started on docetaxel 112mg and trastuzumab 600mg treatments. However, she developed a docetaxel-related grade 1 neutropenia and allergic reaction manifesting as bronchospasm, headache and dyspnoea. The woman’s docetaxel treatment was discontinued after the administration of the first 2 cycles. She was continued on trastuzumab 600mg chemotherapy. Regardless of the continuation of trastuzumab chemotherapy, the progression of right supraclavicular lymphadenopathy was noted, which suggested towards development of acquired resistance to the trastuzumab treatment. Later, radiotherapy was declined by the radiotherapy team due to the extensive injuries in the neck area, inflammatory BCA component with erythema and thickening of the skin, and right clavicular and scapula associated stage I to IV cervical lymphadenopathy. Considering advanced status of lymphadenopathy and evident inflammatory process in her derma, a paclitaxel treatment was offered, but it was denied due to the previous allergic reaction to docetaxel therapy. Further CT scan revealed the neck and cervical injuries were evident and disease was absent in the skin, muscle, and right lymph node. Because of the unsatisfactory results of the previous treatments, she was initiated on combination therapy of SC trastuzumab 600mg for 28 cycles, capecitabine [xeloda] and pertuzumab. Eventually, improvement in her disease condition with an evident decrease in the progress of cutaneous metastasis was noted after completion of 6 cycles of treatment. Saure Sarria VM, et al. Xeloda Oral, Trastuzumab, and Pertuzumab Combined Drug Therapy Reduced Cervical Lymphadenopathy and Dermal Invol