IntroductionGastric cancer (GC) is the fourth most common type of cancer and the second leading cause of cancer-related deaths in the world [1]. Most patients suffering from the advanced, inoperable or metastatic stage of the disease have 5-year survival rates and are approximately 30% (of the cancer population?) [2]. Validated chemotherapeutic regimens such as fluoropyrimidine and/or platinum-based therapies failed to improve the prognosis of advanced GC that remains poor, with a median overall survival (OS) being around 1 year [3,4]. AbstractHuman epidermal growth factor receptor 2 (HER2) is responsible for the pathogenesis and poor outcomes of several types of cancers, including advanced gastric and gastroesophageal junction cancer. Molecular-targeted drugs on the other hand, such as trastuzumab, prolong overall survival and progression-free survival in HER2-positive gastric cancer. The purpose of the case report is to evaluate the impact of delivering trastuzumab in advanced gastric cancer with concomitant HER2 mutation and amplification.Keywords: Gastric cancer; Human epidermal growth factor receptor 2; CT scan; Trastuzumab; Biopsy Therefore, there is an urgent need for targeted-driven approaches toward deregulated molecular signaling pathways in advanced GC such as phosphatidylinositol -4, 5-bisphosphate 3-kinase, catalytic subunit alpha (PIK3CA) pathway or epidermal growth factor receptor (EGFR) pathway. HER2 is the first validated treatment target in HER2-positive GC. HER2 amplification is reported in 7-34% of tumor cases [5,6]. Although anti-HER2 therapy such as Trastuzumab confers clinical benefit on GC patients, its efficacy was shown to be unsatisfactory due to primary or acquired resistance [7][8][9]. The ToGA trial [7] reported a prolongation of median OS by a modest 2.7 months (from 11.1 months to 13.8 months) with Trastuzumab.Fragments of DNA shed by cancers into the bloodstream can potentially be used as a non-invasively screening method for earlystage cancers, monitor responses to treatment and explains why some cancers are resistant to therapies. For most neoplasms, a tissue biopsy is quite challenging in that it is costly, painful, unreachable, insufficient amount of staining or potentially risky for the patient. All these are good reasons to learn about cancer through blood and to get excited about the possibility of carrying out liquid biopsies. The development of non-invasive methods to detect and monitor cancers continues to be a major challenge in oncology. Cell-free circulating tumor DNA (ctDNA) and circulating tumor cells (CTCs) are plasma sources of tumor DNA that have been investigated for non-invasive detection and monitoring of patient tumors but have not been analyzed or directly compared across multiple tumor types. Although the current Food and Drug Administration (FDA)-approved liquid biopsy measures intact CTCs to give a prognosis of overall survival, the potential predictive value of ctDNA is much more exciting. ctDNA liquid biopsy allows us to understand specifically what ki...
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