Li Cheukfai, Ren Chongyang, Wen Lingzhu, Chen Xiaoqing, Chen Bo, Zhang Guochun, Wang Yulei, Li Kai, Cao Li, Jia Minghan, Mok Hsiaopei, Lai Jianguo, Xiao Weikai, Li Xuerui, Liao Ning
Department of Breast Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
Clin Med Insights Oncol. 2022 Feb 23;16:11795549211072880. doi: 10.1177/11795549211072880. eCollection 2022.
Breast cancer is highly heterogenous with temporal and spatial heterogeneity making it necessary for rebiopsy. DS-8201a, a new potential therapy for human epidermal growth factor receptor 2 (HER2) low expression breast cancer, had been proved that it could overcome heterogenous HER2 expression in a preclinical setting. In January 2014, a 23-year-old woman was presented with a lump in the right breast with bone metastasis, diagnosed as infiltrating ductal carcinoma, estrogen receptor (ER)+, progesterone receptor (PR)+, HER2 immunohistochemistry (IHC) 2+, and fluorescence in situ hybridization negative. The patient received a series of therapies including surgery, radiotherapy, endocrine therapy, target therapy, and chemotherapy. The longest progression-free survival was 17 months after surgery. Biopsy of liver metastasis in February 2020 showed triple negative (HER2-, ER-, PR-), which was quite different from the initial diagnosis in 2014, so retesting was performed and the results showed ER-, PR+ by 10%, HER2 IHC score of 1+, indicating heterogeneity of HER2 expression. In May 2020, DS-8201a treatment was initiated and continued for 10 cycles until November 2020. Remarkable relief in symptoms was observed after the first dose. A reduction in the metastatic lesion size (liver and brain) and improved liver function was observed during the therapy. This case indicated the heterogeneity of breast cancer, and impressive efficacy of DS-8201a in a heavily treated patient with HER2-low and HER2 heterogeneity.
乳腺癌具有高度异质性，其时间和空间上的异质性使得再次活检成为必要。DS-8201a是一种针对人表皮生长因子受体2（HER2）低表达乳腺癌的新型潜在疗法，已证实在临床前研究中它可以克服HER2表达的异质性。2014年1月，一名23岁女性因右乳肿块伴骨转移就诊，诊断为浸润性导管癌，雌激素受体（ER）阳性、孕激素受体（PR）阳性、HER2免疫组化（IHC）2+，荧光原位杂交阴性。患者接受了包括手术、放疗、内分泌治疗、靶向治疗和化疗在内的一系列治疗。术后最长无进展生存期为17个月。2020年2月对肝转移灶进行活检显示为三阴性（HER2阴性、ER阴性、PR阴性），这与2014年的初始诊断有很大不同，因此进行了重新检测，结果显示ER阴性、PR阳性率为10%、HER2 IHC评分为1+，表明HER2表达存在异质性。202年5月开始使用DS-8201a治疗并持续了10个周期直至2020年11月。首剂用药后观察到症状明显缓解。治疗期间观察到转移病灶大小（肝脏和脑部）减小且肝功能改善。该病例表明了乳腺癌的异质性，以及DS-8201a在一名接受过大量治疗的HER2低表达且HER2异质性患者中的显著疗效。
