Limited clinical benefit from trastuzumab in recurrent endometrial cancer: two case reports
I Vandenput1, I Vanden Bempt, K Leunen
1Leuven Cancer Institute, Division of Gynecological Oncology, UZ Gasthuisberg, Katholieke Universiteit Leuven, Leuven, Belgium.
Background:
It is hypothesized that the HER-2/neu receptor could be used for targeted therapy in recurrent endometrial cancer.
Cases:
A patient with type II endometrial cancer (serous), showing strong HER-2/neu overexpression and gene amplification in both primary and recurrent tumor, received single-agent trastuzumab (3x weekly, 8 mg/kg loading, 6 mg/kg maintenance dose). Because of progression after 4 cycles, weekly paclitaxel-trastuzumab (80 mg/m(2) paclitaxel; trastuzumab 4 mg/kg loading, 2 mg/kg maintenance dose) was initiated. However, progressive disease was also noted after 11 weeks of combined treatment. A second patient, with recurrent type II endometrial cancer (grade III endometrioid), had HER-2/neu gene amplification in the primary tumor. However, biopsy from a lung metastasis 3 years later appeared to be HER-2/neu-negative.
Conclusion:
Based on lack of response and changes in tumor biology, trastuzumab was of little clinical value in 2 cases of recurrent type II endometrial cancer. This report underscores the importance of reassessment of a recurrent tumor before initiating targeted treatment.
Insights
Trastuzumab showed limited clinical benefit for HER-2/neu positive recurrent endometrial cancer. Reassessing tumor biology is crucial before initiating targeted therapies for endometrial cancer.
Area of Science:
- Oncology
- Molecular Biology
- Genetics
Background:
- Investigating targeted therapy for recurrent endometrial cancer.
- Hypothesizing the role of HER-2/neu receptor in treatment strategies.
- Evaluating HER-2/neu as a therapeutic target in advanced endometrial cancer.
Observation:
- Two patients with recurrent type II endometrial cancer were treated with trastuzumab.
- One patient exhibited HER-2/neu overexpression and gene amplification.
- The second patient showed HER-2/neu gene amplification initially, but later tested negative.
Findings:
- Trastuzumab monotherapy and combination therapy with paclitaxel did not prevent disease progression.
- Tumor biology assessment is critical for effective targeted treatment selection.
- HER-2/neu status may change during the course of recurrent endometrial cancer.
Implications:
- Trastuzumab may have limited efficacy in HER-2/neu-positive recurrent endometrial cancer.
- Re-biopsy and reassessment of tumor markers are essential before retreatment.
- This case series highlights the dynamic nature of tumor markers in endometrial cancer progression.
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