Hepatoid esophagogastric adenocarcinoma and tumoral heterogeneity: a case report

Hepatoid adenocarcinoma of the stomach is an uncommon subtype of gastric cancer remarkably similar to hepatocellular carcinoma in histopathological analysis. It is also commonly associated with high serum alfa-fetoprotein and a poorer prognosis, despite the emergence of new therapeutic options. In recent years, next generation sequencing (NGS) technology has made it possible to identify and describe the genes and molecular alterations common to gastric cancer thereby contributing to the advancement of targeted therapies. A 62-year-old patient, with no prior risk factor for hepatocellular carcinoma (HCC), presented to the emergency room with dysphagia for solids, abdominal pain and weight loss of about 3 kilograms over 3 months. Histopathological analysis presented with disparities regarding HER2 and programmed death-ligand 1 (PD-L1) status in the primary and metastatic sites. We describe a case of a de novo metastatic, human epidermal growth factor receptor 2 (HER2) positive esophagogastric junction hepatoid adenocarcinoma. Although this is a rare subgroup of gastric cancer, treatment strategies were based in recent studies in immunotherapy and guided therapy, taking into consideration the molecular findings from the patient’s tumor NGS analysis. Data about HER2 and PDL1 heterogeneity were also reviewed. Despite the aggressiveness and rarity of this histology, the patient had a good response to treatment.     

HER2 expression in gastric and oesophageal cancer: a meta-analytic review

Background

Since the advent and the success of adjuvant medical therapy for human epidermal growth factor receptor 2 (HER2)-positive breast cancer in the form of trastuzumab there has been increasing interest in the development of similar therapies in other solid organ malignancies including gastric cancer and oesophageal cancer. Over the years, multiple observational studies have been inconsistent. Several meta-analyses have been published looking at the association between HER2 and gastric cancer and oesophageal cancer. This review aims to summarize the meta-analytic evidence for the association between HER2 in gastric and oesophageal cancer.

Methods

A systematic search was conducted using MEDLINE, PubMed, EMBASE, Current Contents Connect, Cochrane Library, Google Scholar, Science Direct, and Web of Science.

Results

Of the articles selected, only nine studies met full criteria. Six of them reviewed the role of HER2 in gastric cancer and the remaining three reviewed its role in oesophageal cancer.

Conclusions

The current evidence regarding the role of HER2 is unclear. However, it clearly plays a key role in the pathogenesis of gastric and oesophageal carcinomas. Targeted therapy towards this subgroup (despite variable frequency and association with survival) would offer a mortality benefit and improve survival.     

HER2 discordance between paired primary gastric cancer and metastasis:a meta-analysis

Background:A number of stuthes have examined human epidermal growth factor receptor 2(HER2)status in primary gastric cancer(GC) and associated metastasis,some showed their great concordance in HER2 expression,but others demonstrated notable discordance.There is still little consensus on HER2 discordance,therefore,a systematic review and meta-analysis was conducted to assess the status on HER2 discordance between primary GC and its paired metastasis.Methods:PubMed,EMBASE,ASCO and The Cochrane Library were searched for stuthes that explored the concordance between primary tumor and metastasis in patients with GC up to 10 March,2014.Data of discordance of HER2 between primary GC and corresponding metastasis were extracted from the publications and random-effects models were used to estimate pooled discordance proportions.Results:Eighteen articles including 1,867 patients were included for the meta-analysis in accordance with the selection criteria.Pooled discordance proportions were 7%[95%confidence interval(CI):5-10%]for HER2 status.Pooled proportions of tumors shifting from positive to negative and from negative to positive were 17%(95%CI:7-29%) and 4%(95%CI:2-6%) respectively.No publication bias was found in the meta-analysis.Conclusions:The discordance of HER2 status is not rare in primary and metastatic GC through our metaanalysis.Prospective stuthes are needed to testify the clinical significance of the discordance of HER2 status.     

HER2阳性浸润性乳腺癌新辅助治疗反应的预测因子及治疗前后HER2状态变化的评估

背景与目的： 人表皮生长因子受体2（human epidermal growth factor receptor 2,HER2）阳性浸润性乳腺癌对抗于HER2新辅助治疗的反应显著,然而不同患者的反应并不一致,部分反应较差。本研究旨在探讨HER2阳性乳腺癌新辅助治疗反应的预测因子,并进一步评估新辅助治疗前后HER2状态的不一致性。方法： 收集深圳市人民医院2019—2021年经术前粗针穿刺活检确诊的110例HER2阳性乳腺癌患者,经新辅助治疗后行手术切除。采用免疫组织化学（immunohistochemistry,IHC）及荧光原位杂交（fluorescence in situ hybridization,FISH）检测术前穿刺标本中的HER2表达状态,并评估新辅助治疗后手术切除标本的病理学完全缓解（pathological complete response,pCR）状态及残余肿瘤负荷（residual cancer burden,RCB）分级,评价不同HER2状态对新辅助治疗效果的影响,并进一步比较新辅助治疗前后HER2、雌激素受体（estrogen receptor,ER）及孕激素受体（progesterone receptor,PR）状态的一致性。结果 ：110例乳腺癌患者根据HER2 IHC表达状态分为弥漫3+组（81例）、异质性3+组（20例）和2+且FISH基因扩增（2+FISH+）组（9例）。HER2弥漫3+组pCR率为54.3%,明显高于异质性3+组（5.0%）和2+FISH+组（11.1%）,差异有统计学意义（P<0.05）,而异质性3+组和2+FISH+组的RCB分级更高。多因素分析显示,HER2弥漫3+是pCR的独立预测因子。7例（11.9%）HER2阳性乳腺癌患者在新辅助治疗后HER2转为阴性,大多数（85.7%）为异质性3+组和2+FISH+组病例。结论： HER2异质性会影响HER2阳性乳腺癌的新辅助治疗反应,评价穿刺活检标本中HER2 IHC异质性,并对新辅助治疗后残留癌灶HER2、ER和PR状态重新评估,有利于指导下一步治疗。新型抗体药物偶联物（antibody-drug conjugate,ADC）的出现有望为HER2异质性阳性乳腺癌患者带来生存获益。     

HER2阳性乳腺癌治疗模式的进展和优化

随着抗人表皮生长因子受体2（human epidermalgrowth factor receptor 2 ,HER2）抗肿瘤药物的不断出现及广泛应用,HER2 阳性乳腺癌患者的治疗以及预后得到了显著的改善。PEONY 研究结果的发布再次奠定了帕妥珠单抗+曲妥珠单抗的双靶治疗模式在新辅助治疗领域中的地位;结合TRYPHAENA 和TRAIN-2 两项研究,紫杉类+铂类应该是抗HER2 双靶治疗的首选化疗方案,疗程宜6 个周期。结合中国乳腺癌新辅助治疗专家共识和辅助APT 研究的最新随访结果,新辅助治疗适用人群为肿瘤直径超过3 cm 和/或淋巴结阳性的患者,新辅助治疗后如果没有获得pCR,T-DM1 应该是辅助治疗的首选模式,帕妥珠单抗+曲妥珠单抗的双靶辅助模式期待PEONY 研究的后续生存随访;对于没有淋巴结转移的小肿瘤（≤3 cm）低危患者可以考虑免除新辅助治疗,采取直接手术+术后给予曲妥珠单抗联合单药紫杉醇的辅助治疗模式。曲妥珠单抗+帕妥珠单抗联合紫杉类药物依然是晚期HER2 阳性患者的标准一线治疗;对于中国患者而言,吡咯替尼联合卡培他滨可以作为二线的优选;T-DM1 可以作为三线及后线选择;曲妥珠单抗、帕妥珠单抗、T-DM1 治疗失败的情况下,DS-8201 成为新的选择模式;伴有脑转移的HER2 阳性晚期乳腺癌患者则可以考虑图卡替尼与曲妥珠单抗和卡培他滨的联合治疗模式。     

HER2-positive,trastuzumab-resistant metastatic esophageal cancer presenting with brain metastasis after durable response to dual HER2 blockade: a case report

We here report a case of a patient diagnosed with human epithelial growth factor receptor 2 (HER2)-amplified esophageal adenocarcinoma. The patient responded well to trastuzumab-based chemotherapy initially, but progressed with liver metastases. Her treatment was then switched to dual HER2 blockade with both trastuzumab and lapatinib in combination with capecitabine. She tolerated therapy and responded remarkably well with radiographic resolution of liver metastases. Unfortunately, she developed multiple brain metastases in the absence of extracranial progression. Discordant negative expression of HER2 and subclonal mutations in brain lesions were discovered, which, at least in part, explained her brain metastases in the presence of capecitabine and lapatinib, as both agents are known to be able to cross the blood brain barrier. The potential mechanism for dual HER2 blockade is discussed in the context of HER2-positive, trastuzumab-resistant, advanced esophageal cancer. The incidence of brain metastasis in advanced gastro-esophageal cancer has been reported to be extremely low, but is expected to increase with more effective systemic therapy. The intratumoral heterogeneity between the metastases, local recurrences and the primary tumor is definitely noteworthy.     

Clinicopathological and prognostic significance of EGFR, VEGF, and HER2 expression in cholangiocarcinoma

Epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF), and human epidermal growth factor receptor 2 (HER2) have been considered as potential therapeutic targets in cholangiocarcinoma, but no studies have yet clarified the clinicopathological or prognostic significance of these molecules. Immunohistochemical expression of these molecules was assessed retrospectively in 236 cases of cholangiocarcinoma, as well as associations between the expression of these molecules and clinicopathological factors or clinical outcome. The proportions of positive cases for EGFR, VEGF, and HER2 overexpression were 27.4, 53.8, and 0.9% in intrahepatic cholangiocarcinoma (IHCC), and 19.2, 59.2, and 8.5% in extrahepatic cholangiocarcinoma (EHCC), respectively. Clinicopathologically, EGFR overexpression was associated with macroscopic type (P=0.0120), lymph node metastasis (P=0.0006), tumour stage (P=0.0424), lymphatic vessel invasion (P=0.0371), and perineural invasion (P=0.0459) in EHCC, and VEGF overexpression with intrahepatic metastasis (P=0.0224) in IHCC. Multivariate analysis showed that EGFR expression was a significant prognostic factor (hazard ratio (HR), 2.67; 95% confidence interval (CI), 1.52-4.69; P=0.0006) and also a risk factor for tumour recurrence (HR, 1.89; 95% CI, 1.05-3.39, P=0.0335) in IHCC. These results suggest that EGFR expression is associated with tumour progression and VEGF expression may be involved in haematogenic metastasis in cholangiocarcinoma.     

EGFR,HER2和HER3在胆管癌中的表达及预后价值

目的 观察表皮生长因子受体(Epidermal growth factor receptor,EGFR)、表皮生长因子受体2(Human epidermal growth factor receptor 2,HER2)和表皮生长因子受体3(Human epidermal growth factor receptor 3,HER3)在胆管癌(Cholangiocarcinoma,CCA)组织中的表达情况,探讨其与CCA患者临床病理特征、总生存期和CCA细胞增殖的关系。方法 收集2009年1月—2013年10月于我院手术的CCA患者50例,并同时收取癌旁组织作为对照。采用免疫组织化学方法及RT-PCR方法检测CCA及癌旁组织中EGFR、HER2和HER3表达情况。收集患者临床病理参数,分析EGFR、HER2和HER3表达与CCA临床病理参数之间的关系。绘制Kaplan-Meier生存曲线,采用Log-rank检验和Cox比例风险模型分析EGFR、HER2和HER3表达情况与50例CCA患者术后总生存期之间的关系。采用RNA干扰方法敲低CCA细胞株QBC939中EGFR、HER2和HER3表达,Western blot检测EGFR、HER2和HER3敲低效果,MTT方法检测EGFR、HER2和HER3对QBC939细胞增殖的影响。结果 CCA组织中可检测到EGFR、HER2和HER3的阳性表达。临床病理特征关系分析结果显示,HER2表达与CCA淋巴结转移相关(P＜0.05);而EGFR和HER3除与CCA淋巴结转移相关外,还与肿瘤分化程度相关(P＜0.05)。EGFR、HER2和HER3阳性患者术后总生存期明显低于阴性患者(P＜0.05)。敲低CCA QBC939细胞中EGFR、HER2和HER3表达后,QBC939细胞增殖能力显著降低(P＜0.05)。结论 CCA组织中EGFR、HER2和HER3表达与患者总生存期密切相关,机制可能与促进CCA细胞的增殖相关。     

肿瘤细胞中HER2与脂肪酸合酶的关系

脂肪酸代谢和机体的能量平衡与肿瘤发生发展密切相关。脂肪酸合成酶（fatty acid synthase, FASN）作为一个代谢性癌基因,是能量链中的核心分子。近年来不少研究发现FASN和人表皮生长因子受体2（human epidermal growth factor receptor 2, HER2）之间存在双向分子联系,共同促进癌细胞转化、增殖、侵袭、转移、耐药等。本文对肿瘤细胞中二者相互作用作一综述。     

Novel Therapies for the Treatment of HER2-Positive Advanced Breast Cancer: A Canadian Perspective

The advent of anti-HER2 targeted therapies has dramatically improved the outcome of HER2-positive breast cancer; however, resistance to treatment in the metastatic setting remains a challenge, highlighting the need for novel therapies. The arrival of new treatment options and clinical trials examining the efficacy of novel agents may improve outcomes in the metastatic setting, including in patients with brain metastases. In the first-line setting, we can potentially cure a selected number of patients treated with pertuzumab + trastuzumab + taxane. In the second-line setting, clinical trials show that trastuzumab deruxtecan (T-DXd) is a highly effective option, resulting in a shift from trastuzumab emtansine (T-DM1) as the previous standard of care. Moreover, we now have data for patients with brain metastases to show that tucatinib + trastuzumab + capecitabine can improve survival in this higher-risk group and be an effective regimen for all patients in the third-line setting. Finally, we have a number of effective anti-HER2 therapies that can be used in subsequent lines of therapy to improve patient outcomes. This review paper discusses the current treatment options and presents a practical treatment sequencing algorithm in the context of the Canadian landscape.     

子宫内膜癌组织HER2表达水平与患者临床病理特征的关系探讨

目的 探讨子宫内膜癌组织中人表皮生长因子受体2(HER2)的表达水平及其临床意义.方法 选取84例子宫内膜癌组织标本为病例组,30例正常子宫内膜组织标本为对照组,采用免疫组化染色方法检测两组标本中HER2蛋白的表达水平,分析HER2蛋白表达水平与子宫内膜癌患者临床病理特征的关系.结果 病例组组织标本中HER2蛋白的阳性表达率为55.95％,高于对照组的26.67％,差异有统计学意义(P﹥0.05);肌层浸润深度﹥1/2、Ⅲ期和Ⅳ期、低分化、发生淋巴结转移、肿瘤累及宫颈组织的子宫内膜癌患者子宫内膜癌组织中HER2蛋白阳性表达率高于肌层浸润深度≤1/2、Ⅰ期和Ⅱ期、高分化和中分化、未发生淋巴结转移、肿瘤未累及宫颈组织的子宫内膜癌患者,差异均有统计学意义(P﹤0.05).结论 子宫内膜癌组织中HER2蛋白的表达上调,并且与肿瘤浸润深度、临床分期、分化程度、淋巴结转移及是否累及宫颈组织有关.     

Multifactorial central nervous system recurrence susceptibility in patients with HER2-positive breast cancer: epidemiological and clinical data from a population-based cancer registry study

BACKGROUND:

A series of retrospective studies have reported that patients with human epidermal growth factor receptor 2(HER2)‐positive breast cancer are at a greater risk of central nervous system (CNS) metastases. Trastuzumab, which does not cross the blood‐brain barrier, has been associated with this increased risk.

METHODS:

The authors evaluated incidence, survival, and risk factors for CNS metastases in the incident breast cancer population systematically collected by the Parma Province Cancer Registry over the 4‐year period between 2004 and 2007.

RESULTS:

A total of 1458 patients with a diagnosis of stage I to III invasive breast cancer were analyzed for study purposes. At a median follow‐up of 4.1 years, CNS events were observed in 1.3% and 5% of HER2‐negative patients and HER2‐positive patients, respectively (P < .0001). The administration of trastuzumab either as adjuvant therapy or for metastatic disease was associated with a significantly increased risk of CNS involvement at first disease recurrence and after first extracranial recurrence, respectively. According to multivariate analysis, HER2‐positive status and trastuzumab treatment, high Ki‐67 index, and hormone receptor negativity remained independent risk factors for the development of CNS metastasis.

CONCLUSIONS:

To the authors' knowledge, this is the first population‐based cancer registry study analyzing factors associated with CNS recurrence in a general population of newly diagnosed breast cancer patients with known HER2 status. The data from the current study provide evidence that patients with HER2‐positive breast cancer have a significantly higher incidence of CNS metastasis after treatment with trastuzumab. Improvements in systemic control and overall survival associated with trastuzumab‐based therapy may lead to an “unmasking” of CNS disease recurrence that would otherwise remain clinically silent before a patient's death. Cancer 2011. © 2010 American Cancer Society.     

重组抗HER2融合蛋白基因ScFv/tBid对骨肉瘤E10细胞的促凋亡作用

目的：构建抗HER2重组融合蛋白基因ScFv/tBid,并探讨其对骨肉瘤E10细胞的促调亡作用。方法：通过间接免疫荧光染色、流式细胞仪（FCM）检测E10细胞膜表面HER2的表达。将抗HER2单链抗体基因e23sFv与铜绿假单胞菌外毒素PE的转膜结构域基因（PEⅡ）和tBid基因连接,构建抗HER2重组融合蛋白基因ScFv/tBid,将其克隆入真核表达载体pCMV中构建重组pCMV-ScFv/tBid载体,转染骨肉瘤E10细胞。间接免疫荧光法检测目的蛋白表达和细胞形态学变化,Annexin V染色流式细胞术及TUNEL法检测E10细胞的凋亡情况。结果：流式细胞仪检测到E10细胞膜表面有HER2的表达。成功构建重组融合蛋白基因质粒pCMV-ScFv/tBid。重组质粒转染E10细胞后,间接免疫荧光双标记染色检测到E10细胞中tBid的过表达;细胞色素C在细胞质中出现;细胞出现明显的固缩、核浓缩等形态特征。Annexin V染色后流式细胞仪检测可见实验组细胞凋亡率较对照组明显升高（16.1% vs 4.5%）;TUNEL染色显示,E10细胞出现典型的凋亡特征。结论：重组抗HER2融合蛋白基因ScFv/tBid可以在转染的骨肉瘤E10细胞中表达,并诱导骨肉瘤细胞发生凋亡。