Department of Chemotherapy and Palliative Care, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan
Anticancer Res. 2014 Feb;34(2):867-72.
We report on a case of human epidermal growth factor receptor-2 (HER2)-positive gastric cancer with paraaortic lymph node metastasis. The patient (a 49-year-old female) received chemotherapy (capecitabine and cisplatin) plus molecular-targeted therapy (trastuzumab), followed by curative resection. Interestingly, the resected residual cancer was HER2-negative. Intra-tumor heterogeneity hinders molecular-targeted therapy for gastric cancer. In our case, continued trastuzumab administration presented few benefits since the residual cancer cells were HER2-negative. No consensus exists regarding the appropriate therapy for unresectable gastric cancers whose non-curative factors disappear following trastuzumab chemotherapy. The principal options are treatment with surgery or continued chemotherapy with trastuzumab. In our case, resection treated the HER2-negative residual cancer effectively, resulting in curative therapy. This is the first case of positive-to-negative change in the HER2 expression of residual tumor cells following trastuzumab therapy. It suggests that, due to intra-tumor heterogeneity, the risks presented by remnant HER2-negative cancer cells persist despite trastuzumab therapy.
我们报告了一例人表皮生长因子受体 2（HER2）阳性胃腺癌伴paraaortic 淋巴结转移。该患者（49 岁女性）接受了化疗（卡培他滨和顺铂）加分子靶向治疗（曲妥珠单抗），随后进行了根治性切除。有趣的是，切除的残余癌为 HER2 阴性。肿瘤内异质性阻碍了胃癌的分子靶向治疗。在我们的病例中，由于残余癌细胞为 HER2 阴性，继续使用曲妥珠单抗治疗获益有限。对于不可切除的胃癌，在曲妥珠单抗化疗后非治愈因素消失后，尚无关于合适治疗方法的共识。主要的选择是手术治疗或继续曲妥珠单抗化疗。在我们的病例中，切除有效地治疗了 HER2 阴性的残余癌，实现了治愈性治疗。这是首例曲妥珠单抗治疗后残余肿瘤细胞 HER2 表达由阳性转为阴性的病例。这表明，由于肿瘤内异质性，尽管进行了曲妥珠单抗治疗，残余 HER2 阴性癌细胞带来的风险仍然存在。
