Department of Oncology, Anqing Municipal Hospital, Anqing, Anhui, China.
Cancer Rep (Hoboken). 2023 Sep;6(9):e1864. doi: 10.1002/cnr2.1864. Epub 2023 Jul 28.
Human epidermal growth factor receptor 2 (HER2) overexpression is an independent prognostic factor of poor prognosis and a predictor of efficacy of anti-HER2 therapy. A limited number of patients can receive standard second-line therapy (DS-8201 or T-DM1) for metastatic HER2-positive in some parts of the world, including China, due to many factors, such as cost-benefit ratios.
A 51-year-old premenopausal woman was diagnosed with HER2-positive breast cancer. The pathological stage was ypT3N2M0 and stage IIIA. Trastuzumab targeted therapy combined with goserelin depot was started along with letrozole endocrine therapy. After eight courses of treatment, magnetic resonance imaging (MRI) examination revealed new multiple metastases in the liver, and progression disease (PD) was evaluated. Due to abnormal activation of the phosphatidylinositol 3-kinase/protein kinase B/mammalian target of rapamycin (PI3K/AKT/mTOR) pathway in the patient, treatment was changed to the mammalian target of rapamycin (mTOR) inhibitor combined with the anti-HER-2 agents inetetamab and paclitaxel, while partial response (PR) was evaluated after 6 cycles of treatment. As the patient was hormone receptor (HR) positive, treatment was changed to the inetetamab + rapamycin + exemestane regimen. The lesion continued to shrink and PR was evaluated for 8 cycles. The original regimen was continued, PR was evaluated after 12 courses of treatment. The abdominal MRI performed showed an increase in the volume of intrahepatic multiple metastatic tumor lesion. Efficacy was used to assess for PD and the progression-free survival (PFS) was 317 days.
A phosphatidylinositol-4, 5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA) mutation in trastuzumab-treated metastatic HER2-positive breast cancer female had a long PFS by treating with the mammalian target of rapamycin inhibitor in combination with the anti-HER-2 agent inetetamab.
人表皮生长因子受体 2（HER2）过表达是预后不良的独立预后因素，也是抗 HER2 治疗疗效的预测因子。由于成本效益比等诸多因素，世界上包括中国在内的一些地区，只有少数转移性 HER2 阳性患者能够接受标准二线治疗（DS-8201 或 T-DM1）。
一名 51 岁绝经前女性被诊断为 HER2 阳性乳腺癌。病理分期为 ypT3N2M0 和 IIIA 期。曲妥珠单抗靶向治疗联合戈舍瑞林 depot 联合来曲唑内分泌治疗。治疗 8 个疗程后，磁共振成像（MRI）检查显示肝脏新出现多处转移，评估为进展性疾病（PD）。由于患者存在磷脂酰肌醇 3-激酶/蛋白激酶 B/哺乳动物雷帕霉素靶蛋白（PI3K/AKT/mTOR）通路异常激活，治疗方案改为雷帕霉素靶蛋白（mTOR）抑制剂联合抗 HER-2 药物伊替莫单抗和紫杉醇，治疗 6 个周期后评估为部分缓解（PR）。由于患者为激素受体（HR）阳性，治疗方案改为伊替莫单抗+雷帕霉素+依西美坦。病灶持续缩小，治疗 8 个周期后评估为 PR。继续原方案治疗，治疗 12 个疗程后评估为 PR。进行腹部 MRI 检查显示肝内多发转移瘤病灶体积增大。疗效评估为 PD，无进展生存期（PFS）为 317 天。
曲妥珠单抗治疗的转移性 HER2 阳性乳腺癌女性中存在磷脂酰肌醇-4,5-二磷酸 3-激酶催化亚单位α（PIK3CA）突变，通过联合使用雷帕霉素靶蛋白抑制剂和抗 HER-2 药物伊替莫单抗治疗，可获得较长的 PFS。
