%0 Journal Article
%T Personalized therapy based on sequential molecular analysis leads to 30 months of survival in a patient with diffuse unresectable gastric linitis plastica
%A Anas Gazzah
%A Christophe Massard
%A Cora Sternberg
%A Diane Goere
%A Fabio Calabro
%A Fabiola Cecchi
%A Jean-Charles Soria
%A Julien Adam
%A Linda Mahjoubi
%A Ludovic Lacroix
%A Lukas Heukamp
%A Maximiliano Gelli
%A Michel Ducreux
%A Patrizia Trenta
%A Philippe Jamme
%A Rastislav Bahleda
%A Todd Hembrough
%J Tumori Journal
%@ 2038-2529
%D 2018
%R 10.1177/0300891618763215
%X Diffuse gastric cancer is associated with poor prognosis. We report a patient with metastatic gastric linitis plastica harboring human epidermal growth factor receptor 2 (HER2) activating mutation and HER2 amplification. The patient received 5-fluorouracil/folinic acid and oxaliplatin combined with trastuzumab/pertuzumab, resulting in disease control for 8 months. Second-line therapy with nivolumab and trastuzumab/pertuzumab was well-tolerated, with macroscopic peritoneal response. Following ovarian progression and surgical resection of ovarian metastases, immunohistochemistry of PD-L1 was negative; proteomics demonstrated normal expression of HER2 and absence of PD-L1, while genomics showed HER2 amplification, suggesting mechanisms of escape to dual HER2 blockade by downregulation of HER2 and to nivolumab by the absence of PD-L1. Based upon this and nonexpression of biomarkers of taxane resistance, therapy was changed to paclitaxel. Two and a half years after diagnosis, the patient is undergoing treatment, with excellent performance status. Molecular analysis and personalized therapy can help optimize treatment in difficult-to-treat cancers
%K Stomach
%K cancer
%K survival
%K trastuzumab
%U https://journals.sagepub.com/doi/full/10.1177/0300891618763215