PMC9868577_01
Treatment protocol before trastuzumab therapy. (A) CT scans (2020.6.25) showed the patient's baseline disease; (B) CT scans (2020.8.25) demonstrated progressive disease (PD) in multiple lymph nodes metastases when first-line chemotherapy failed. (C) CT scans (2020.10.15) revealed new liver metastases when the second-line chemotherapy failed.
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CT (2020.6.25) scans demonstrated gastric antrum lesions with multiple metastases of hepatogastric and retroperitoneal lymph nodes (Figure 1A). CT scans (2020.8.25) revealed disease progression in multiple lymph nodes (Figure 1B). New liver lesions appeared, and the primary tumor and lymph nodes increased (2020.10.15, Figure 1C).
CT scans identified liver lesions during trastuzumab treatment. (A) CT scans (2020.12.15) demonstrated progressive disease (PD) in liver metastases after trastuzumab plus chemotherapy treatment. (B) CT (2021.8.10) showed that liver lesions had markedly shrunken 8 months after trastuzumab, apatinib and camrelizumab treatment. (C) The PR status (2022.4.19) continued with trastuzumab, apatinib and camrelizumab treatment until upper gastrointestinal bleeding happened.
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CT scans (2020.12.15) showed increased liver lesions (Figure 2A). The optimal efficacy was partial response (PR) (2021.8.10, Figure 2B).
(A). HE staining of gastric lesions (x400); (B). HER2 positive on gastric cancer cells; (C): PD-L1 negative on gastric cancer cells; (D): HE staining of liver lesions (x400); (E): HER2 positive on liver lesions; (F): PD-L1 positive on liver lesions.
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Immunohistochemistry (IHC) revealed that tumor cells were HER2 3+ and negative for PD-L1 in gastric lesions (Figures 3A-C). IHC confirmed HER2 3+ and PD-L1 positive in liver lesions (Figures 3D-F). The triple regimens continued until upper gastrointestinal bleeding took place, and the patient had to discontinue apatinib (2022.4.19, Figure 3C).
Information of this case report has been organized into a timeline.
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ADC-RC48. A summary of her treatment history is illustrated in Figure 4.