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Various toxicities: case report A 72-year-old woman developed severe osteoporosis and osteoporotic fracture of the right humerus during treatment with letrozole, and pulmonary embolism and deep vein thrombosis (DVT) of the lower limbs during treatment with tamoxifen for breast cancer [not all dosages and outcomes stated; routes and durations of treatments to reactions onsets not stated]. The woman, who had a history of hypothyroidism, hypertension, non-resectable right breast cancer in the tail of Spence and metastasis to bones and lungs, was referred to the Internal Medicine Department at the Oncology Centre because of progressive bone pain, weakness and shortness of breath. There laboratory tests showed grade II invasive ductal carcinoma of the breast with the positive profile for the androgen receptor, estrogen receptor, progesterone receptor. Due to the progression of cancer, she did not undergo a mastectomy. Therefore, she was started on letrozole and was continued for the next year. At the same time, she presented with severe bone pain and underwent a cycle of palliative radiotherapy. After about 11 months of surveillance, she had an osteoporotic fracture of the right humerus and was treated with surgery. Because of severe osteoporosis and breast cancer progression, letrozole was switched to tamoxifen 20 mg/day as a second line treatment. After discharge and surgery, she did not receive any antithrombotic prevention treatment. After 5 months of starting tamoxifen, during a follow-up, an angiogram-CT of pulmonary arteries showed a massive thrombus in the right pulmonary artery along with partially blocked left pulmonary artery in its distal part. Compression ultrasonography of lower limb veins showed DVT of the right lower limb veins and partial blockage in the distal fragment of the vessel of tight of the left lower limb. Based on these findings, a diagnosis was made with pulmonary embolism due to deep vein thrombosis of the lower limbs. The woman stopped receiving tamoxifen and treatment with enoxaparin was started. During further hospitalisation, she was in stable condition and gradual reduction of breathlessness with improving physical performance was also noted. After 7 days of stable general condition, she was discharged on enoxaparin. In the next follow-up, an angiogram-CT of pulmonary arteries showed regression of thromboembolic lesions and she was suitable for further for enoxaparin therapy and palliative radiotherapy because of bone pain. Tomaszewska A, et al. The pulmonary embolism after switching from letrozole to tamoxifen in a patient with breast cancer. A case report and literature review. OnCOReview 803501602 10: 31-36, No. 1, 2020. Available from: URL: http://doi.org/10.24292/01.OR.120311320

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