Twenty-eight months progression-free survival after pyrotinib therapy for HER2-positive recurrent ovarian clear cell carcinoma: a case report

Abstract

Background: Ovarian cancer (OC) is the seventh most common newly diagnosed cancer in women worldwide. Ovarian clear cell carcinoma (OCCC) is a specific type of epithelial ovarian cancer with a poor prognosis. It has been revealed that human epidermal growth factor receptor 2 (HER2)-positive (2+/3+) has been observed in 14% to 45.6% of patients with OCCC. Anti-HER2 therapy has been demonstrated to be an effective strategy for the treatment of HER2-positive breast cancer. However, the role of anti-HER2 therapy in OC remains largely unknown. This case report is the first report suggesting a 28-month PFS of pyrotinib in HER2-positive OCCC.Case Description: A 67-year-old female patient with HER2-positive OCCC was admitted to our hospital because of fever, who benefited greatly from treatment with pyrotinib, an irreversible HER2 antagonist conditionally approved for patients with advanced or metastatic HER2-positive breast cancer in China. The patient, who had previously been diagnosed with stage I A OCCC [according to the International Federation of Gynecology and Obstetrics (FIGO)] and undergone radical surgery with standard adjuvant chemotherapy on May 15, 2017, was diagnosed with HER2-positive OCCC at FIGO stage III C . She was treated with oral pyrotinib (400 mg/day in 21-day cycles) starting on November 27, 2018. Imaging assessments were conducted every 2 to 4 treatment cycles. Best response by response evaluation criteria in solid tumors (RECIST) 1.1 were partial response. However, on March 30, 2021, the patient was assessed using contrastenhance CT and found to have progressive disease with liver metastases. Subsequently, on April 26, 2021, the patient underwent liver microwave ablation and ultrasound-guided liver biopsy. The immunohistochemistry results of the liver biopsy showed the origin of the disease to be ovarian. Therefore, the disease was identified as HER2-positive OCCC at FIGO stage IV B .Conclusions: Progression-free survival (PFS) in second-line chemotherapy for patients with recurrent OC ranges from 3.8 to 11.3 months. In the case of this patient, treatment with pyrotinib yielded a PFS of 28 months, which was a promising result for the use of pyrotinib in treating HER2-positive OC.

Exploration and prognostic analysis of two types of high-risk ovarian cancers: clear cell vs. serous carcinoma: a population-based study

“…Therefore, in the absence of standard treatment for OCCC and with immunotherapy demonstrating initial success in other tumors, there is an urgent imperative to identify tumour-specific antigens of OCCC. While there is still little research on targeted therapies for OCCC, a team from Zhongshan Hospital in China recently revealed a case of a patient with advanced Human epidermal growth factor receptor 2 (HER2) -positive OCCC, who was treated with pyrotinib and achieved a PFS of 28 months [55]. This study was based on the fact that the HER2 is positively expressed in 14-45.6% of patients with OCCC [56,57].…”

Case report: Long-term clinical benefit of pyrotinib therapy following trastuzumab resistance in HER2-amplification recurrent mucinous ovarian carcinoma

“…Huang et al (34) additionally revealed that for HER2-positive advanced gastric cancer patients who have developed a resistance to trastuzumab, pyrotinib is a promising new treatment that can be used as salvage therapy. In a recent case, a patient treated with pyrotinib yielded a PFS of 28 months, a promising result for the use of pyrotinib in treating HER2-positive ovarian clear cell carcinoma (32). Whether or not pyrotinib is effective in trastuzumabresistant MOC is currently unclear.…”

“…Because targeting HER2 has been a pivotal treatment strategy for HER2-positive breast cancer, the strategy has potential promise for treating HER2-positive ovarian cancer. Importantly, a case of successful treatment with pyrotinib for HER2-positive ovarian cancer ( 32 ). We have a surprising treatment result of using pyrotinib on an ovarian cancer patient whose HER2 study was positive.…”