Targeting HER2 and Focusing on Patients With Gastric Cancer

Jose Maria Vieitez, MD, PhDAssistant Professor of OncologyDepartment of Medical Oncology

Hospital Universitario Central de AsturiasOviedo, Spain

Patient History and Presentation of Disease

• Personal history:– 46-year-old woman– No other relevant history

• Family history:– Paternal grandfather: stomach cancer (51 years old)– Maternal aunt: breast cancer (45 years old)

• Disease presentation: February 2008– Decreased appetite, early satiety, weight loss, and vomiting

Diagnosis: Stage IV Adenocarcinoma of Stomach

• Gastroscopy: ulcerated lesion in antrum– Biopsy: poorly differentiated, diffuse adenocarcinoma

• CT scan and abdominal echography– Liver lesions: 2.1 and 0.7 cm

• Tumor markers: elevated CEA, CA 19.9 and CA 72.4

CA = carbohydrate antigen; CEA = carcinoembryonic antigen; CT= computed tomography

Treatment

• Surgical resection: April 2008– Partial gastrectomy and left anexectomy– Miliary lesions in peritoneum, lesions in liver and left ovary

• Systemic therapy: May 2008– Cycle 1–6: cisplatin 70 mg/m2, capecitabine 850 mg/m2 D1–14

Based on the literature: HER2 testing requested– HER2 test result: IHC 3+

• Cycle 7–27: trastuzumab 6 mg/kg/q3w + capecitabine

HER2 = human epidermal growth factor receptor 2; IHC = immunohistochemistry

Tumor Assessment: Stable Disease at Cycle 3

Baseline: before treatment Cisplatin + capecitabine

May 2008 Sep 2008

Imaging studies property of Jose Maria Vieitez, MD.

Tumor Assessment: Complete Response at Cycle 17

Trastuzumab + capecitabine

Imaging studies property of Jose Maria Vieitez, MD.

Tumor Assessment: Disease Progression at Cycle 27

Trastuzumab + capecitabine

• Good quality of life and symptom relief

• Grade 1 anemia• Grade 2 asthenia• Grade 3 vomiting

(responded to antiemetics)

Time to progression: 17 months

Jan 2010

Imaging studies property of Jose Maria Vieitez, MD.

Conclusions

• Treatment with trastuzumab is well tolerated, even in prolonged treatment

• Addition of trastuzumab in appropriately selected patients can increase efficacy, time to progression, and overall survival outside of clinical trial setting