A significant response to a combination of trastuzumab and vinorelbine in HER2-negative metastatic breast cancer with HER2 V777L mutation

Dramatic Response to Pyrotinib and T-DM1 in HER2-Negative Metastatic Breast Cancer With 2 Activating HER2 Mutations

HER2 signaling is activated in response to somatic HER2 mutations, which are often found in invasive lobular breast cancer (ILC) and are associated with poor prognosis. Tyrosine kinase inhibitors (TKIs) have demonstrated considerable antitumor activity in patients with HER2-mutated advanced breast cancer (BC). Further, several clinical trials have indicated that HER2-targeted antibody-drug conjugates (ADCs) exhibit promising efficacy in lung cancer with HER2 mutations, and the efficacy of ADCs against HER2-mutated BC is currently being evaluated. Several preclinical studies have demonstrated that the therapeutic efficacy of ADCs in HER2-mutated cancer can be enhanced by the addition of irreversible TKIs, but the potential of such a combined treatment regimen for the treatment of HER2-mutated BC has not been reported. Herein, we describe a case in which a patient with estrogen receptor-positive/HER2-negative metastatic ILC with 2 activating HER2 mutations (D769H and V777L) exhibited a significant and durable response to anti-HER2 treatment with pyrotinib (an irreversible TKI) in combination with ado-trastuzumab emtansine, which was administered after multiple lines of therapy that had resulted in disease progression. Further, based on the evidence from the present case, TKI plus ADC seems to be a promising combination anti-HER2 regimen for patients with HER2-negative/HER2-mutated advanced BC, although further rigorous studies are warranted to confirm these findings.

Advances in EGFR/HER2-directed clinical research on breast cancer

The discovery of the HER2 molecules has embarked a series of investigations on the efficacy and safety of different types of anti-HER2 therapies for treating breast cancer, with the clinical pathway requiring a more detailed, more precise, and more dynamics therapeutic approaches due to the heterogeneity of the disease. As the "do more" and "do less" approaches are becoming more important to personalize treatment for early HER2-positive breast cancer, recent advances aim at tackling the advanced stage of the disease by using novel therapeutic agents and combination strategies. There are also important points of consideration on prognosis and choice of therapies, including HER2 gene copy number, HER2 heterogeneity, tissue biomarkers, blood-based biomarkers, and HER2 mutation and its treatment. Altogether, these could potentially play a vital role in the journey of HER2-positive breast cancer patient to achieve greater survival benefit and potentially a cure for the disease.

An immunohistochemical study of HER2 expression in primary brain tumors

Background

Primary brain tumors (PBTs) include any tumor in the brain whose prognosis is weak because of their histological characteristics.

Aim

Herein, this study aimed to assess the HER2 tumor marker frequency in PBTs.

Materials and methods

This study was done on the samples of primary brain tumor diagnosis from 2008 to 2015.

Results

Out of 107 patients of brain tumor that had a mean age of 40.4 years (61.7% men), the most common location of the tumor was in the supratentorial region (63.85% cases). The prevalence of high-grade astrocytoma (HGA) and low-grade astrocytoma (LGA) at diagnosis was 43.9% and 37.4%, respectively. With regard to HER2 score, HER2-positive (scores 2 & 3) was in 42.1% of patients. On the other hand, HER2-negative (−) was in 57.9%, 2+ in 33.6%, and 3+ in 8.4% of patients. The patients of LGA had significantly younger ages, lower HER2 positivity, and lower HER2 percent compared with the HGA patients.

Conclusions

The type of brain tumors can impact on HER2 expression that high HER2 expression in HGA may be helpful for therapeutic aims. Further studies are required to support these results with a higher volume of patients in the world.