title: Human Epidermal Growth Factor Receptor 2 (HER-2/neu)-Directed Therapy for Rare Metastatic Epithelial Tumors with HER-2 Amplification.
abstract: METHODS
  A 67-year-old Asian female was diagnosed with locally advanced high-grade salivary duct carcinoma in June 2011. Molecular analysis revealed human epidermal growth factor receptor 2 (HER-2) amplification. She received adjuvant therapy with carboplatin/paclitaxel/ trastuzumab and maintenance of trastuzumab. Upon disease progression, trastuzumab could not be continued due to lack of financial coverage. Instead, she was treated with compassionate use of lapatinib from April 2013 and standard 5-fluorouracil. Her disease ultimately progressed and she expired later in 2013.
  
  
  METHODS
  A 68-year-old Asian male was diagnosed with extramammary Paget's disease of the scrotum with HER-2 amplification in May 2011. He received 6 cycles of adjuvant trastuzumab/docetaxel/carboplatin followed by maintenance trastuzumab, which was changed to compassionate use of lapatinib as his insurance did not cover further administration of trastuzumab. He showed clinical benefits from single-agent lapatinib and a combination of lapatinib/capecitabine upon progression to the single-agent lapatinib. Ultimately, he was started on ado-trastuzumab emtansine, which was approved at that time by the FDA for HER-2-positive breast cancer progressed on trastuzumab. He is having clinical and radiographic complete response based on current imaging and normalization of his tumor markers.
  
  
  CONCLUSIONS
  HER-2-targeted therapy should be considered for tumors with HER-2 amplification. In our case series, we would like to emphasize this approach in other rare histologies. Specifically, our patient with extramammary Paget's disease of the scrotum represents the first reported case of a non-breast, non-gastric tumor with HER-2 overexpression with complete clinical and radiographic response to HER-2-targeted therapy.
authors.affiliation: Division of Hematology-Oncology, Department of Medicine, University of California Los Angeles, Los Angeles, Calif., USA; Departments of Molecular, Cellular and Integrative Physiology, University of California Los Angeles, Los Angeles, Calif., USA.
authors.forename: Daniel Sanghoon
authors.initials: DS
authors.lastname: Shin
authors.affiliation: Departments of Molecular, Cellular and Developmental Biology, University of California Los Angeles, Los Angeles, Calif., USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Sherry
authors.affiliation: Departments of Pathology and Laboratory Medicine, University of California Los Angeles, Los Angeles, Calif., USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Kallen
authors.affiliation: Division of Hematology-Oncology, Department of Medicine, University of California Los Angeles, Los Angeles, Calif., USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Wong
authors.affiliation: Division of Hematology-Oncology, Department of Medicine, University of California Los Angeles, Los Angeles, Calif., USA.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Drakaki
keywords: Extramammary Paget's disease of the scrotum; Human epidermal growth factor receptor 2; Salivary duct carcinoma