Sustained Clinical Benefit of Pyrotinib Combined with Capecitabine Rescue Therapy After Trastuzumab Resistance in HER2-Positive Advanced Gastric Cancer: A Case Report

Xin Li,1,* Xiaoqiang Gu,1,* Jiahua Xu,1,* Ling Chen,2,* Hongwei Li,1 Dan Meng,1 Haoran Bai,1 Jinzu Yang,1 Jianxin Qian1 1Department of Oncology, Longhua Hospital affiliated to Shanghai University of Traditional Chinese Medicine (TCM), Shanghai, 200032, People’s Republic of China; 2Department of Oncology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine affiliated to Shanghai University of Traditional Chinese Medicine (TCM), Shanghai, 200437, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jinzu Yang; Jianxin QianDepartment of Oncology, Longhua Hospital affiliated to Shanghai University of Traditional Chinese Medicine (TCM), Shanghai, 200032, People’s Republic of ChinaEmail kingzuy@126.com; jianxinqiang3@163.comBackground: HER2-positive patients with advanced gastric cancer have a poor prognosis, and trastuzumab-resistant patients lack effective treatment.Case Presentation: We report a 72-year-old male with HER2-positive gastric cancer. The patient had metastatic tumor during adjuvant chemotherapy after surgery, followed by second-line chemotherapy, and achieved a progression-free survival (PFS) of 4.5 months. Subsequent third-line chemotherapy treatment also failed. Fortunately, the patient had a significant tumor response and 8.5 months of PFS on trastuzumab combined with chemotherapy. After trastuzumab resistance, the patient was treated with programmed cell death protein-1 inhibitor combined with apatinib, which selectively inhibited VEGFR2, but the effect was not satisfactory. Finally, the patient was treated with capecitabine combined with pyrotinib, an irreversible TKI, acting on HER2. The tumor shrank significantly after this treatment.Conclusion: The mechanism and countermeasures of trastuzumab resistance were discussed in this case. For patients with HER2-positive advanced gastric cancer, pyrotinib can achieve good results after trastuzumab resistance.Keywords: HER2, gastric cancer, trastuzumab, pyrotinib