Personalized therapy based on sequential molecular analysis leads to 30 months of survival in a patient with diffuse unresectable gastric linitis plastica
| Autor: | Fabio Calabrò, Christophe Massard, Michel Ducreux, Lukas Heukamp, Todd Hembrough, Anas Gazzah, Patrizia Trenta, Jean-Charles Soria, Diane Goéré, Cora N. Sternberg, Ludovic Lacroix, Rastislav Bahleda, Maximiliano Gelli, Julien Adam, Fabiola Cecchi, Linda Mahjoubi, Philippe Jamme |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Oncology
Cancer Research medicine.medical_specialty Poor prognosis Receptor ErbB-2 Linitis plastica Linitis Plastica 03 medical and health sciences 0302 clinical medicine Stomach Neoplasms Trastuzumab Internal medicine Antineoplastic Combined Chemotherapy Protocols Humans Medicine 030212 general & internal medicine Precision Medicine Personalized therapy skin and connective tissue diseases Human Epidermal Growth Factor Receptor 2 business.industry Stomach Cancer General Medicine Middle Aged medicine.disease Molecular analysis medicine.anatomical_structure 030220 oncology & carcinogenesis Female business medicine.drug |
| Zdroj: | Tumori Journal. 104:NP38-NP41 |
| ISSN: | 2038-2529 0300-8916 |
| Popis: | Introduction: Diffuse gastric cancer is associated with poor prognosis. We report a patient with metastatic gastric linitis plastica harboring human epidermal growth factor receptor 2 ( HER2) activating mutation and HER2 amplification. Case description: The patient received 5-fluorouracil/folinic acid and oxaliplatin combined with trastuzumab/pertuzumab, resulting in disease control for 8 months. Second-line therapy with nivolumab and trastuzumab/pertuzumab was well-tolerated, with macroscopic peritoneal response. Following ovarian progression and surgical resection of ovarian metastases, immunohistochemistry of PD-L1 was negative; proteomics demonstrated normal expression of HER2 and absence of PD-L1, while genomics showed HER2 amplification, suggesting mechanisms of escape to dual HER2 blockade by downregulation of HER2 and to nivolumab by the absence of PD-L1. Based upon this and nonexpression of biomarkers of taxane resistance, therapy was changed to paclitaxel. Two and a half years after diagnosis, the patient is undergoing treatment, with excellent performance status. Conclusions: Molecular analysis and personalized therapy can help optimize treatment in difficult-to-treat cancers. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|