Dauerhafte Remission unter dualer HER2-Blockade mit Trastuzumab und Pertuzumab bei metastasiertem Gallenblasenkarzinom

Zusammenfassung

Gallenblasenkarzinome stellen eine seltene, aber aggressive Tumorerkrankung dar. Der einzige kurative Ansatz besteht in der chirurgischen Resektion, jedoch kommt es häufig zu einem Rezidiv der Tumorerkrankung. Die Kombinationschemotherapie aus Cisplatin und Gemcitabin führte im lokal fortgeschrittenen oder metastasierten Stadium zu einem Überlebensvorteil gegenüber einer Gemcitabin-Monotherapie, es gibt jedoch keine anerkannte Zweitlinientherapie bei Progress. Wir berichten über eine junge Patientin mit frühem Rezidiv eines Gallenblasenkarzinoms mit kutaner und peritonealer Metastasierung, bei der durch Exomsequenzierung im Rahmen des NCT MASTER (Molecularly Aided Stratification for Tumor Eradication Research)-Programms eine Amplifikation des ERBB2-Gens mit daraus resultierender Überexpression von HER2 in den Tumorzellen festgestellt wurde. Da das Rezidiv unter der additiven Chemotherapie mit Oxaliplatin und Gemcitabin aufgetreten war, wurde die Patientin mit einer zielgerichteten Therapie mit dualer HER2-Blockade in Kombination mit nab-Paclitaxel behandelt. Mit diesem Behandlungsregime konnte eine Remission erreicht werden, die mittlerweile seit mehr als einem Jahr andauert. Dieser Fallbericht verdeutlicht das Potenzial einer auf molekularen Veränderungen basierenden Therapie von Gallenwegskarzinomen und den Bedarf für entsprechende klinische Studien.

Abstract

Gallbladder cancer represents a rare but dismal disease. The only curative option is complete surgical resection, though patients often develop recurrent disease. In patients with advanced biliary tract cancer, the combination of cisplatin and gemcitabine showed a benefit in overall survival compared to gemcitabine alone. However, there is no standardized second-line regimen after treatment failure. We report on a young patient with early recurrence of a gallbladder cancer with cutaneous and peritoneal metastases. Upon identification of an ERBB2 gene amplification within the NCT MASTER (Molecularly Aided Stratification for Tumor Eradication Research) exome sequencing program with resulting overexpression of HER2 in the tumors cells, the patient received a targeted therapy with the HER2 antibodies pertuzumab and trastuzumab in combination with nab-paclitaxel, which led to a durable remission for more than one year. This case report underlines the potential of molecularly aided personalized targeted therapy for patients with biliary tract cancer and the need for respective clinical trials.

Schlüsselwörter

Gallenwegskarzinome - Gallenblasenkarzinom - HER2 - Pertuzumab - Trastuzumab

Key words

biliary tract cancer - gall bladder cancer - HER2 - Pertuzumab - Trastuzumab

^* Sektion Personalisierte Onkologie.

^§ Geteilte Letztautorschaft.

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