Sustained Clinical Benefit of Pyrotinib Combined with Capecitabine Rescue Therapy After Trastuzumab Resistance in HER2-Positive Advanced Gastric Cancer: A Case Report

• Published in: OncoTargets and therapy Vol. 14; pp. 3983 - 3989
• Main Authors: Li, Xin, Gu, Xiaoqiang, Xu, Jiahua, Chen, Ling, Li, Hongwei, Meng, Dan, Bai, Haoran, Yang, Jinzu, Qian, Jianxin
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 01.01.2021; Taylor & Francis Ltd; Dove
• Subjects: Abdomen; Antigens; Apoptosis; Back pain; Breast cancer; Cancer; Cancer therapies; Capecitabine; Care and treatment; Case Report; Cell death; Chemotherapy; Coronary vessels; Development and progression; Epidermal growth factor; ErbB-2 protein; FDA approval; Gastric cancer; Immunotherapy; Lymphatic system; Medical imaging; Medical prognosis; Mesentery; Metastases; Metastasis; Patients; Potassium; Prognosis; Stomach cancer; Surgery; Tomography; Trastuzumab; Vascular endothelial growth factor; China; East Asia; Japan; trastuzumab; gastric cancer; HER2; pyrotinib
• ISSN: 1178-6930; 1178-6930
• DOI: 10.2147/OTT.S310421

HER2-positive patients with advanced gastric cancer have a poor prognosis, and trastuzumab-resistant patients lack effective treatment. We report a 72-year-old male with HER2-positive gastric cancer. The patient had metastatic tumor during adjuvant chemotherapy after surgery, followed by second-line chemotherapy, and achieved a progression-free survival (PFS) of 4.5 months. Subsequent third-line chemotherapy treatment also failed. Fortunately, the patient had a significant tumor response and 8.5 months of PFS on trastuzumab combined with chemotherapy. After trastuzumab resistance, the patient was treated with programmed cell death protein-1 inhibitor combined with apatinib, which selectively inhibited VEGFR2, but the effect was not satisfactory. Finally, the patient was treated with capecitabine combined with pyrotinib, an irreversible TKI, acting on HER2. The tumor shrank significantly after this treatment. The mechanism and countermeasures of trastuzumab resistance were discussed in this case. For patients with HER2-positive advanced gastric cancer, pyrotinib can achieve good results after trastuzumab resistance.