PMC9304692_01
Hematoxylin-Eosin staining (A) and immunohistochemical staining of HER2 expression (B).
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IV,  Figure 1A ). HER2 positive (3+,  Figure 1B ). In addition, laboratory examinations revealed elevations in the levels of carbohydrate antigen 19-9 (CA19-9; 17463 U/ml), carbohydrate antigen 724 (CA724; 415.5 U/ml) and carcinoembryonic antigen (CEA; 50.41 ng/ml). He underwent 6 cycles of combination therapy composed of trastuzumab plus oxaliplatin and paclitaxel.
Computed tomography during treatment (A), blood tumor antigen changes (B), and timeline of the clinical course in this patient (C).
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Liver metastatic lesions (left lobe of liver, 2.66x2.12 cm; right lobe of liver, 2.59x1.56 cm) and hilar lymph node (1.24x0.97 cm) were shrunk, so that the efficacy was assessed as partial response (PR) according to iRECIST criteria ( Figure 2A ), followed by maintenance therapy with trastuzumab. After 4 cycles, although no abnormalities were observed in CEA, CA19-9, or CA724, CT showed spleen metastasis (1.34x1.23 cm) and brain metastasis (2.06x1.60 cm), with the efficacy defined as progressive disease (PD) ( Figure 2A ). However, CA724 (27.6 U/ml) was significantly elevated ( Figure 2B ). The efficacy was evaluated as stable disease (SD) ( Figure 2A ). April 27, 2021. At a recent re-examination, CT showed an increased left lobe of liver mass (3.23x1.71 cm) with effect assessed as PD ( Figure 2A ). Eventually second-line treatment of PFS of up to 20 months was given ( Figure 2C ).