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Various toxicities: case report An approximately 56-year-old woman developed back pain, joint pain, muscle pain, pain in the legs, burning sensation at the surgical site on her neck, burning sensation in the lower stomach, flushing, weakness, hand tremors in the morning causing depression, anaemia, neuropathy, bleeding gums, hair thinning or loss, shortness of breath, increased heart rate (HR), hepatotoxicity, thrombocytopenia, neutropenia, leucopenia and hypersensitivity reactions during treatment with fulvestrant or palbociclib for metastatic multifocal invasive ductal carcinoma of breast [routes and frequency of dose administration not stated; not all durations of treatments to reactions onsets and outcomes stated]. The woman underwent mammography in April 2012 at the age of 50 years. Subsequently, she was diagnosed with multifocal invasive ductal carcinoma of breast. In May 2012, a lumpectomy was performed. Till September 2012, she received radiation therapy twice. In September 2016, metastasis at C7-T1 vertebrae was observed. In October 2016, resection of the involved C7-T1 and placement of a titanium implant (at C6-T2) was performed. From October 2016 to March 2017, she received dish-cultured Antrodia cinnamomea for her health-related conditions. In February 2018, bone metastases involving left side vertebral C7-T2 transverse process and lamina and right side of the T3 vertebral body and lamina. From March 2018, she started receiving adjuvant therapy with fulvestrant 500mg and palbociclib 125mg. In the first week after initiation of fulvestrant, she developed prominent side effects including back pain, joint and muscle pain, pain in the legs, a burning sensation at the surgical site on her neck, a burning sensation in the lower stomach, flushing, weakness and hand tremors in the morning making her depressed. Additionally, she developed palbociclib-related side effects including anaemia, neuropathy, bleeding gums, hair thinning or loss, shortness of breath and increased heart rate. She also developed hepatotoxicity secondary to fulvestrant resulting in increased levels of ALT at the eighteenth day of administration of fulvestrant. Blood and lymphatic system dysfunctions including thrombocytopenia, neutropenia, leucopenia and anaemia, and immune system dysfunctions including hypersensitivity reactions caused by fulvestrant and palbociclib were also noted. Due to the side effects of palbociclib plus fulvestrant, from April 2018, the woman started receiving Antrodia cinnamomea. Consequently, her liver functions improved. From May 2018, she received increased dose of Antrodia cinnamomea till November 2018. Her liver functions remained normal. Thereafter, Antrodia cinnamomea was discontinued till January 2019. Neutrophil and lymphocyte counts returned to normal levels during the periods when the administration of palbociclib was paused or the dose was reduced. In August 2018, follow-up MRI of the cervical spine revealed that the tumors had shrunk. In September 2018, the dosages of fulvestrant and palbociclib w