Expert Perspectives of a 67-Year-Old Man with Metastatic HER2+ Gastric Cancer - Episode 1
John Marshall, MD, reviews the case of a patient with metastatic HER2+ (human epidermal growth factor receptor 2) gastroesophageal junction cancer.
John Marshall, MD: Hello, everybody. My name is Dr John Marshall. I am the Chief of Hematology and Oncology at Georgetown University at the Lombardi Comprehensive Cancer Center in Washington, DC. I'm also the Director of the Otto J. Ruesch Center for the Cure of GI [gastrointestinal] Cancers. I'm pleased that you've joined us for a case-based discussion drilling down on some new data in upper GI cancers, gastric cancer, GE [gastroenterostomy] junction cancer specifically. Our case today is a 67-year-old man who had locally advanced and metastatic HER2-positive gastric cancer. A 67-year-old man comes in, and he presented with new-onset fatigue.
He's got some right upper-quadrant pain that worsened with eating and some unintentional weight loss. He does have a left hip that got fixed, with some arthritis there. He has some hypertension, and a little bit of pre-diabetes. However, his physical exam's unremarkable, as is common in patients like this, and his ECOG [Eastern Cooperative Oncology Group] performance status is 1. He undergoes a typical workup. His hemoglobin is pretty good, at 12. His white [cell] count is 10 and his platelet's 235. He has kidney function, bilirubin, liver function normal. His CEA [ carcinoembryonic antigen] is normal. His CA99 [cancer antigen 19-9] is just marginally elevated at 41, so the tumor markers haven't really helped. He does end up undergoing an upper endoscopy with the finding of a 4-centimeter mass at the GE junction. He undergoes right after that a CT scan showing unresectable liver metastases. The endoscopic biopsy comes back positive for adenocarcinoma, and he gets sent appropriately for testing for HER2. It comes back immunohistochemistry-positive for HER2 at 3-plus, so no reflex testing is needed. PD-L1 [programmed death-ligand 1] is negative, and genetically was found to be microsatellite-stable, all key molecular markers that are needed in a workup of a patient such as this.
This transcript has been edited for clarity.