Clinical Response to T-DM1 in HER2-Amplified, KRAS-Mutated Metastatic Colorectal Cancer

Authors: Jaideep Sandhu MBBS, MPH a , Chongkai Wang MD, MS a and Marwan Fakih MD a
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  • a Department of Medical Oncology, City of Hope National Medical Center, Duarte, California.
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HER2 amplification has been identified in 2% to 3% of all colorectal cancers (CRCs). Although the prognostic role of HER2 amplification in metastatic CRC (mCRC) is unclear, studies have highlighted it as a therapeutic target. In addition, several studies have shown that HER2 amplification is implicated in the resistance to EGFR-targeted therapies. Other studies have provided scientific evidence to support the use of HER2-directed therapies in HER2-amplified CRC; however, thus far this benefit has been limited to the RAS wild-type population. There is an ongoing clinical need to identify novel means of targeting HER2 amplifications in the rare settings of HER2-amplified, RAS-mutated CRC. This case report presents a 58-year-old man with HER2-amplified mCRC and a KRAS G12D mutation whose disease progressed on all standard cytotoxic therapies as well as dual HER2 targeting using trastuzumab and pertuzumab. He subsequently derived a clinical benefit with metastatic lung disease regression on trastuzumab emtansine (T-DM1). He eventually experienced disease progression in the liver after 6 every-3-week cycles. The patient’s response and disease progression were associated with ongoing decline in the HER2 copy number on the circulating tumor DNA assay, suggesting that the mechanism of resistance was related to the loss of HER2 amplification or the emergence of non–HER2-amplified CRC clones. This represents the first report of clinical benefit with T-DM1 in KRAS-mutated HER2-amplified CRC.

Submitted August 13, 2019; accepted for publication October 22, 2019.

Disclosures: Dr. Fakih has disclosed that he receives honoraria, is a consultant, is a scientific advisor, and receives grant/research support from Amgen; is a scientific advisor for Array and Bayer; and receives grant/research support from AstraZeneca and Novartis. The remaining authors have disclosed that they have no financial interests, arrangements, affiliations, or commercial interests with the manufacturers of any products discussed in this article or their competitors.

Correspondence: Marwan Fakih, MD, Department of Medical Oncology, City of Hope National Medical Center, Building 51, Room 112, 1500 East Duarte Street, Duarte, CA 91010. Email: mfakih@coh.org
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