PMC8829539_01
(A) The treatment procedure of the 49-year-old female with stage IV GC. GC, gastric cancer; PFS, progression-free survival; PD, progressive disease. (B) The results of chest computed tomography (CT) scans suggested that liver and lung lesions were reduced in size after first-line treatment. (C) CT results at first relapse in March 2019 and after surgical operation (R0 resection) in September 2019. (D) Fluorescence in situ hybridization (FISH) images demonstrated HER2 amplification. (E) NGS analysis of tumor tissue at diagnosis (pre-resistance) and first relapse (post-resistance). (F) The CT results following second relapse suggested the tumor shrank with third-line treatment. March 2020, Baseline; June and August 2020, during tumor remission; March 2021, tumor progression. (G) The ctDNA status during tumor remission and disease progression.
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A 49-year-old female was diagnosed with stage IV GC with liver and lung metastasis in July 2017 ( Figure 1A ). After 6 months of treatment, the patient achieved complete response (CR) with PFS up to 21 months (Figure 1B). Liver metastasis lesion was curatively resected (R0) and subsequently second-line treatment of trastuzumab (440 mg) plus oxaliplatin (200 mg) was administrated (Figure 1C). Regardless of pre-resistance or post-resistance, both the tumors were HER2-positive (Figure 1D). The NGS results of the primary and liver lesions are shown in  Figure 1E , respectively. After 2 months of treatment, the tumor is evaluated as partial response (PR, Figure 1F). No ctDNA alterations are detected at tumor remission (Figure 1G).