Targeting HER2 and Focusing on Patients With Gastric Cancer

1
Targeting HER2 and Focusing on Patients With
Gastric Cancer

• Jose Maria Vieitez, MD, PhD
• Assistant Professor of OncologyDepartment of
  Medical OncologyHospital Universitario Central
  de AsturiasOviedo, Spain

2
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

3
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
4
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 16 cisplatin 70 mg/m2, capecitabine 850
  mg/m2 D114
• Based on the literature HER2 testing requested
• HER2 test result IHC 3
• Cycle 727 trastuzumab 6 mg/kg/q3w capecitabine

HER2 human epidermal growth factor receptor 2
IHC immunohistochemistry
5
Tumor Assessment Stable Disease at Cycle 3

• Baseline before treatment

• Cisplatin capecitabine

Imaging studies property of Jose Maria Vieitez,
MD.
6
Tumor Assessment Complete Response at Cycle 17

• Trastuzumab capecitabine

Imaging studies property of Jose Maria Vieitez,
MD.
7
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)

Jan 2010
Time to progression 17 months
Imaging studies property of Jose Maria Vieitez,
MD.
8
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