Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 6, 2020; 8(3): 594-599
Published online Feb 6, 2020. doi: 10.12998/wjcc.v8.i3.594
Complete response to trastuzumab and chemotherapy in recurrent urothelial bladder carcinoma with HER2 gene amplification: A case report
Qi Jiang, Mi-Xue Xie, Xiao-Chen Zhang
Qi Jiang, Xiao-Chen Zhang, Department of Medical Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Mi-Xue Xie, Senior Department of Haematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Author contributions: Jiang Q and Zhang XC were the patient’s oncologists, reviewed the literature, and contributed to manuscript drafting; Xie MX analyzed and interpreted the imaging findings; Zhang XC reviewed and edited the manuscript; all authors read and approved the final manuscript.
Supported by Zhejiang Natural Science Foundation-Zhejiang Mathematical and Physical Medical Association, No. SY19H310001.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Xiao-Chen Zhang, MD, Associate Chief Physician, Chief Physician, Department of Medical Oncology, The First Affiliated Hospital, College of Medicine, Zhejiang University, No. 79, Qingchun Road, Hangzhou 310003, Zhejiang Province, China. zhangxiaochen@zju.edu.cn
Received: November 8, 2019
Peer-review started: November 8, 2019
First decision: December 12, 2019
Revised: December 31, 2019
Accepted: January 8, 2020
Article in press: January 8, 2020
Published online: February 6, 2020
Processing time: 79 Days and 15.2 Hours
Abstract
BACKGROUND

Targeted treatments may greatly affect the natural history of urothelial carcinoma based on their pharmacokinetics. A phase II trial has explored the combination of cytotoxic chemotherapy with the anti-HER-2 monoclonal antibody trastuzumab in selected patients with metastatic bladder cancer, but it failed.

CASE SUMMARY

Here, we report a case of recurrent urothelial bladder carcinoma (UBC) in a patient who has undergone three operations, and further illuminate its diagnosis and treatment. The diagnosis of UBC was rendered according to the pathological indices. Next-generation sequencing on formalin fixed paraffin-embedded (FFPE) tissue was also performed and suggested HER2 gene amplification in the FFPE tissue. Based on HER2 gene amplification in FFPE, the patient was treated with chemotherapy in combination with trastuzumab after his third surgery. Fortunately, the patient got a clinically complete remission to trastuzumab for 34 mo.

CONCLUSION

There is not enough clinical evidence for incorporating trastuzumab in routine treatment of UBC. This case hinted that recurrent UBC patients with HER2 gene amplification may benefit from targeted trastuzumab. Further studies are needed to further investigate the status of HER2 gene and better determine trastuzumab in the management of UBC.

Keywords: Urothelial bladder carcinoma; Trastuzumab; Complete response; Next generation sequencing; HER2; Case report

Core tip: Urothelial bladder carcinoma (UBC) is the most common type of urinary system tumor. Approximately 25% of patients present de novo with metastatic disease affecting long-term survival. Although cisplatin-based combination chemotherapy has become the standard first-line regimens for recurrent UBC patients, there are still no second- or third-line treatments for definite efficacy. HER2 gene amplification has been found in UBC patients, but there is not enough clinical evidence for incorporating trastuzumab for treatment of recurrent UBC. This case hinted that recurrent UBC patients with HER2 gene amplification may benefit from targeted trastuzumab, and more cases in the future are needed to confirm our findings.