Mao Sph, Desravines N, Zarei S, Viswanathan A N, Fader A N
Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD, USA.
Gynecol Oncol Rep. 2023 Jul 29;49:101250. doi: 10.1016/j.gore.2023.101250. eCollection 2023 Oct.
Overexpression of HER2 in endometrial cancer is associated with poor prognosis, aggressive disease, and resistance to standard therapies. Recent studies have shown that HER2-targeted therapies, such as trastuzumab, can be effective in treating HER2-positive endometrial cancer in combination with chemotherapy. Currently, the management of advanced-stage HER2-positive uterine serous carcinoma (USC) consists of adjuvant platinum-based chemotherapy with concurrent trastuzumab followed by trastuzumab maintenance therapy until disease recurrence or prohibitive toxicity. In the setting of persistent pelvic disease following systemic therapy, consolidation with tumor-directed radiation therapy also offers an opportunity to eradicate residual disease. With the emergence of molecular tumor classifications and systemic therapies (chemotherapy, immunotherapy, and target therapies), the landscape of adjuvant multi-modality therapy is ever changing and increasingly individualized. Currently, there is no prospective evidence to guide pelvic radiotherapy with concurrent trastuzumab in endometrial cancer, and as a result, no reported toxicity in endometrial cancer patients. In this case report, we present two patients with HER2-positive USC who received multi-agent chemotherapy with trastuzumab followed by pelvic radiation therapy and concurrent trastuzumab. Both patients tolerated this multimodal treatment without significant or persistent moderate or severe adverse events. These two cases provide insight into the safety and feasibility of administering radiation therapy with trastuzumab in endometrial cancer in the maintenance phase. Our report suggests that trastuzumab-based therapy may be a promising treatment option for HER2-positive endometrial cancer patients who receive concurrent or adjuvant chemotherapy and radiation therapy.
HER2在子宫内膜癌中的过表达与预后不良、疾病侵袭性以及对标准治疗的耐药性相关。最近的研究表明，针对HER2的疗法，如曲妥珠单抗，与化疗联合使用时可有效治疗HER2阳性的子宫内膜癌。目前，晚期HER2阳性子宫浆液性癌（USC）的治疗包括辅助铂类化疗联合曲妥珠单抗，随后进行曲妥珠单抗维持治疗，直至疾病复发或出现难以耐受的毒性。在全身治疗后出现持续性盆腔疾病的情况下，采用肿瘤定向放射治疗进行巩固治疗也为根除残留疾病提供了机会。随着分子肿瘤分类和全身疗法（化疗、免疫疗法和靶向疗法）的出现，辅助多模式治疗的格局不断变化且日益个体化。目前，尚无前瞻性证据指导子宫内膜癌患者在接受曲妥珠单抗治疗时进行盆腔放疗，因此，也没有关于子宫内膜癌患者相关毒性的报道。在本病例报告中，我们介绍了两名HER2阳性USC患者，他们接受了含曲妥珠单抗的多药化疗，随后进行盆腔放疗并同时使用曲妥珠单抗。两名患者均耐受了这种多模式治疗，未出现明显或持续的中度或重度不良事件。这两个病例为在维持阶段对子宫内膜癌患者使用曲妥珠单抗进行放射治疗的安全性和可行性提供了见解。我们的报告表明，基于曲妥珠单抗的治疗可能是HER2阳性子宫内膜癌患者在接受同步或辅助化疗及放疗时一种有前景的治疗选择。
