Abstract
A 67-year-old man diagnosed with HER2 overexpression advanced gastric adenocarcinoma and metastasis to liver and lungs was admitted for tertiary care. He received a third line chemotherapy that consists of trastuzumab combined with FOLFIRI regimen (irinotecan plus 5-FU/LV) following a disease relapse after an initial successful response to a combination of 5FU + oxaliplatin and trastuzumab. The patient showed a favorable and prolonged response to it. In addition the chemotherapy was well tolerated and devoid of remarkable side effects. The response to trastuzumab + FOLFIRI was assessed clinically and through CT scan imaging and upper gastrointestinal endoscopy. This case report shows that firstly the combination of FOLFIRI and trastuzumab could be tested as another regimen in metastatic gastric cancer, and, secondly, that in this disease, like in metastatic breast cancer, the continuation of trastuzumab after an initial progression under this antibody could be tested in order to improve the efficacy of the treatment Trastuzumab re-introduction with FOLFIRI for treatment of HER2 overexpression-advanced gastric adenocarcinoma following failure of other trastuzumab-based chemotherapy regimens.
Highlights
Gastric carcinoma is the fourth most common cancer in the world with almost 1 million cases in 2008, and the second most frequent cause of cancer-related death with about 740,000 deaths per year worldwide [1].In the metastatic setting, chemotherapy remains the standard of care, several regimens having shown a benefit in overall survival (OS) in first line treatment
Chemotherapy remains the standard of care, several regimens having shown a benefit in overall survival (OS) in first line treatment
The TOGA study showed that the addition of trastuzumab to fluoropyrimidine and cisplatin improved tumor response rate (RR), progression free survival (PFS) and OS in patients with a human epidermal growth factor receptor 2 (HER2)-positive metastatic gastric cancer [6]
Summary
Gastric carcinoma is the fourth most common cancer in the world with almost 1 million cases in 2008, and the second most frequent cause of cancer-related death with about 740,000 deaths per year worldwide [1]. Chemotherapy remains the standard of care, several regimens having shown a benefit in overall survival (OS) in first line treatment. The TOGA study showed that the addition of trastuzumab to fluoropyrimidine and cisplatin improved tumor response rate (RR), progression free survival (PFS) and OS in patients with a HER2-positive (scored 3+ on immunohistochemistry or 2+ and FISH positive) metastatic gastric cancer [6]. Few recent publications have reported that trastuzumab in combination with FOLFIRI may have some efficacy in second, or more, line of chemotherapy in trastuzumab naïve patients [7] [8]. We hereby report a patient with HER2 overexpression advanced gastric adenocarcinoma with a favorable response to trastuzumab-based first chemotherapy who has been re-challenged with FOLFIRI and Trastuzumab combination in third line treatment following disease progression under a second line chemotherapy
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
