Wu Junyi, Li Lei, Qin Jun, Yan Zhengqing, Chen Shiqing, Jin Tao, Xu Junming
Department of General Surgery, Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
The Medical Department, 3D Medicines Inc., Shanghai, China.
Front Oncol. 2022 Jan 27;11:780577. doi: 10.3389/fonc.2021.780577. eCollection 2021.
Trastuzumab plus chemotherapy remains the standard first-line treatment strategy for HER2-positive gastric cancer (GC). Trastuzumab resistance, on the other hand, remains a significant issue. There are a few effective anti-HER2 agents for patients who develop resistance to trastuzumab.
A 49-year-old female was diagnosed with stage IV GC with liver and lung metastasis in July 2017. She underwent gastrostomy, and the immunohistochemistry (IHC) result of postoperative tissue demonstrated HER2 (3+). She received first-line treatment of trastuzumab (440 mg), oxaliplatin (200 mg), and S-1 (40 mg). After treatment for 6 months, the patient achieved complete response (CR) with PFS up to 21 months. After progression, she subsequently received trastuzumab (440 mg) plus oxaliplatin (200 mg) as second-line treatment. However, the patient developed resistance to trastuzumab after 12 months of treatment. She started to receive third-line treatment of irinotecan (200 mg d1) and capecitabine (60 mg bid) plus pyrotinib (400 mg/day). After 2 months of treatment, the tumor is evaluated as partial response with PFS of 12 months.
We presented a patient with HER2-positive GC who benefited from the pyrotinib-based treatment after two lines of trastuzumab-based therapies failed. Further research is required to validate such conclusions.
曲妥珠单抗联合化疗仍然是HER2阳性胃癌（GC）的标准一线治疗策略。另一方面，曲妥珠单抗耐药仍然是一个重大问题。对于对曲妥珠单抗产生耐药的患者，有几种有效的抗HER2药物。
一名49岁女性于2017年7月被诊断为IV期GC伴肝肺转移。她接受了胃造口术，术后组织的免疫组化（IHC）结果显示HER2（3+）。她接受了曲妥珠单抗（440mg）、奥沙利铂（200mg）和S-1（40mg）的一线治疗。治疗6个月后，患者达到完全缓解（CR），无进展生存期（PFS）长达21个月。病情进展后，她随后接受了曲妥珠单抗（440mg）加奥沙利铂（200mg）作为二线治疗。然而，患者在治疗12个月后对曲妥珠单抗产生了耐药。她开始接受三线治疗，即伊立替康（200mg d1）、卡培他滨（60mg bid）加吡咯替尼（400mg/天）。治疗2个月后，肿瘤评估为部分缓解，PFS为12个月。
我们报告了一名HER2阳性GC患者，在两线基于曲妥珠单抗的治疗失败后，从基于吡咯替尼 的治疗中获益。需要进一步的研究来验证这些结论。
