Shin Daniel Sanghoon, Sherry Timothy, Kallen Michael E, Wong Steven, Drakaki Alexandra
Division of Hematology-Oncology, Department of Medicine, University of California Los Angeles, Los Angeles, Calif., USA; Departments of Molecular, Cellular and Integrative Physiology, University of California Los Angeles, Los Angeles, Calif., USA.
Departments of Molecular, Cellular and Developmental Biology, University of California Los Angeles, Los Angeles, Calif., USA.
Case Rep Oncol. 2016 Jun 11;9(2):298-304. doi: 10.1159/000445827. eCollection 2016 May-Aug.
CASE 1: A 67-year-old Asian female was diagnosed with locally advanced high-grade salivary duct carcinoma in June 2011. Molecular analysis revealed human epidermal growth factor receptor 2 (HER-2) amplification. She received adjuvant therapy with carboplatin/paclitaxel/ trastuzumab and maintenance of trastuzumab. Upon disease progression, trastuzumab could not be continued due to lack of financial coverage. Instead, she was treated with compassionate use of lapatinib from April 2013 and standard 5-fluorouracil. Her disease ultimately progressed and she expired later in 2013.
CASE 2: A 68-year-old Asian male was diagnosed with extramammary Paget's disease of the scrotum with HER-2 amplification in May 2011. He received 6 cycles of adjuvant trastuzumab/docetaxel/carboplatin followed by maintenance trastuzumab, which was changed to compassionate use of lapatinib as his insurance did not cover further administration of trastuzumab. He showed clinical benefits from single-agent lapatinib and a combination of lapatinib/capecitabine upon progression to the single-agent lapatinib. Ultimately, he was started on ado-trastuzumab emtansine, which was approved at that time by the FDA for HER-2-positive breast cancer progressed on trastuzumab. He is having clinical and radiographic complete response based on current imaging and normalization of his tumor markers.
HER-2-targeted therapy should be considered for tumors with HER-2 amplification. In our case series, we would like to emphasize this approach in other rare histologies. Specifically, our patient with extramammary Paget's disease of the scrotum represents the first reported case of a non-breast, non-gastric tumor with HER-2 overexpression with complete clinical and radiographic response to HER-2-targeted therapy.
病例1：一名67岁的亚洲女性于2011年6月被诊断为局部晚期高级别涎腺导管癌。分子分析显示人表皮生长因子受体2（HER-2）扩增。她接受了卡铂/紫杉醇/曲妥珠单抗辅助治疗，并维持使用曲妥珠单抗。疾病进展后，由于经济覆盖不足，无法继续使用曲妥珠单抗。取而代之的是，从2013年4月起她接受了拉帕替尼的同情用药治疗以及标准的5-氟尿嘧啶治疗。她的疾病最终进展，于2013年晚些时候去世。
病例2：一名68岁的亚洲男性于2011年5月被诊断为阴囊外佩吉特病伴HER-2扩增。他接受了6个周期的曲妥珠单抗/多西他赛/卡铂辅助治疗，随后维持使用曲妥珠单抗，由于其保险不涵盖曲妥珠单抗的进一步给药，改为拉帕替尼的同情用药。他在疾病进展为单药拉帕替尼治疗时，显示出单药拉帕替尼以及拉帕替尼/卡培他滨联合用药的临床获益。最终，他开始使用ado-曲妥珠单抗恩美曲妥珠单抗治疗，当时该药物已被美国食品药品监督管理局批准用于曲妥珠单抗治疗进展的HER-2阳性乳腺癌。根据目前的影像学检查以及肿瘤标志物的正常化情况，他实现了临床和影像学完全缓解。
对于HER-2扩增的肿瘤应考虑HER-2靶向治疗。在我们的病例系列中，我们想强调在其他罕见组织学类型中采用这种治疗方法。具体而言，我们的阴囊外佩吉特病患者代表了首例报道的非乳腺、非胃的HER-2过表达肿瘤，对HER-2靶向治疗有完全的临床和影像学反应。
