Trastuzumab deruxtecan (DS8201) for advanced non-small cell lung cancer with HER2 exon 20 insertion mutation: a case
Xincheng He1, Lei Hou1, Jun Bai1
1Department of Clinical Oncology, Shaanxi Provincial People's Hospital, Xi'an.
Abstract:
An antibody-drug conjugate (ADC) of human epidermal growth factor receptor-2 (HER2) provides effective treatment for patients with HER2-positive non-small cell lung cancer (NSCLC). Exon 20 insertion mutations are the most common among HER2 mutations. This mutant subtype is highly drug-resistant, and patients receiving conventional treatment often have a poor prognosis. Trastuzumab deruxtecan (T-DXd), a novel anti-HER2 ADC, has emerged as a novel treatment option for HER2-positive (mutated, expressed, amplified, alternated) NSCLC, based on several studies and reported results. Herein, we report a case of stage IV NSCLC with HER2 exon 20 mutation in a 52-year-old male patient whose tumor recurred after radical resection of pulmonary carcinoma, who could not tolerate chemotherapy, and presented with bone metastasis. After treatment with T-DXd, the tumor significantly regressed and bone metastasis improved, maintaining a state of no progression for 21 months. This case report evidences the use of T-DXd in the treatment of NSCLC with HER2 exon 20 insertion mutation.
Insights
Trastuzumab deruxtecan (T-DXd) effectively treated a patient with advanced non-small cell lung cancer (NSCLC) harboring a HER2 exon 20 mutation. This novel antibody-drug conjugate (ADC) led to significant tumor regression and improved bone metastasis, offering a new option for this resistant cancer.
Area of Science:
- Oncology
- Medical Genetics
- Pharmacology
Background:
- HER2-positive non-small cell lung cancer (NSCLC) with exon 20 insertion mutations presents a significant therapeutic challenge due to inherent drug resistance.
- Conventional chemotherapy often yields poor outcomes for patients with this specific HER2 mutation subtype.
Observation:
- A case report details a 52-year-old male with stage IV NSCLC and a HER2 exon 20 mutation who experienced tumor recurrence post-surgery and bone metastasis.
- The patient could not tolerate standard chemotherapy treatments.
Findings:
- Treatment with trastuzumab deruxtecan (T-DXd), a targeted anti-HER2 antibody-drug conjugate (ADC), resulted in substantial tumor regression.
- The patient achieved a 21-month progression-free survival, with marked improvement in bone metastasis after T-DXd therapy.
Implications:
- This case highlights T-DXd as a promising and effective treatment strategy for NSCLC patients with HER2 exon 20 insertion mutations.
- The findings suggest T-DXd could overcome resistance mechanisms associated with HER2 mutations in NSCLC, improving patient prognosis.
