Li Xiao-Qian, Yang Jing, Liu Bo, Han Shu-Mei
Department of Medical Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan 510000, Shandong Province, China.
World J Clin Oncol. 2024 Oct 24;15(10):1351-1358. doi: 10.5306/wjco.v15.i10.1351.
In patients with human epidermal growth factor receptor 2 (HER2)-overexpressing gastric cancer (GC), the combination of HER2 targeting and a standard first-line chemotherapy regimen has been demonstrated to significantly improve their prognosis. However, in a proportion of patients, cancer progresses within a short period of time, and there is currently no standard treatment after disease progression.
This study presents a case of a 51-year-old male with advanced GC who underwent radical resection (Billroth type II subtotal gastrectomy and gastrojejunostomy) and resection of liver metastases. Immunohistochemical staining revealed a HER2 score of 2+, a dMMR status, and a Ki67 proliferation index of 30% to 40%. The gene test results indicated the presence of ERBB2 amplification and a PD-L1 expression level of less than 5%. Since December 2021, the patient has experienced disease progression during both first-line (two cycles of KN026 combined with KN046) and second-line (five cycles of nivolumab combined with trastuzumab and SOX chemotherapy) treatment regimens. The patient's prognosis following the first and second lines of treatment was unfavorable, with progression occurring in a relatively short time. For third-line therapy, disitamab vedotin (RC48) plus apatinib was used. At the time of this report, the patient had achieved a progression-free survival (PFS) of 25.8 months, which exceeded the median survival time for patients with advanced GC.
Despite the unfavorable prognosis associated with advanced GC, the implementation of personalized treatment approaches may still prove beneficial for select patients. In patients with HER2-positive GC with extensive metastatic involvement, the use of the HER2-targeted combination with apatinib has demonstrated the potential to prolong both PFS and overall survival.
在人表皮生长因子受体2（HER2）过表达的胃癌（GC）患者中，HER2靶向治疗与标准一线化疗方案联合应用已被证明可显著改善其预后。然而，在一部分患者中，癌症在短时间内进展，目前疾病进展后尚无标准治疗方案。
本研究报告了1例51岁晚期GC男性患者，该患者接受了根治性切除术（毕Ⅱ式胃大部切除术和胃空肠吻合术）及肝转移灶切除术。免疫组化染色显示HER2评分为2+，错配修复缺陷（dMMR）状态，Ki67增殖指数为30%至40%。基因检测结果显示存在ERBB2扩增，程序性死亡受体配体1（PD-L1）表达水平低于5%。自2021年12月起，该患者在一线治疗方案（KN026联合KN046两个周期）和二线治疗方案（纳武利尤单抗联合曲妥珠单抗及SOX化疗五个周期）期间均出现疾病进展。该患者一线和二线治疗后的预后均不佳，在相对较短的时间内出现进展。三线治疗采用了迪西他单抗维泊妥珠单抗（RC48）联合阿帕替尼。在本报告发布时，该患者的无进展生存期（PFS）达到了25.8个月，超过了晚期GC患者的中位生存时间。
尽管晚期GC预后不佳，但实施个性化治疗方法可能仍对部分患者有益。在HER2阳性且有广泛转移的GC患者中，使用HER2靶向治疗联合阿帕替尼已显示出延长PFS和总生存期的潜力。
