Article Text

Download PDFPDF
Original article
Liquid biopsies to track trastuzumab resistance in metastatic HER2-positive gastric cancer
  1. De-Shen Wang1,2,
  2. Ze-Xian Liu1,
  3. Yun-Xin Lu1,2,
  4. Hua Bao3,
  5. Xue Wu3,
  6. Zhao-Lei Zeng1,
  7. Zekun Liu1,
  8. Qi Zhao1,
  9. Cai-Yun He1,4,
  10. Jia-Huan Lu1,2,
  11. Zhi-Qiang Wang1,2,
  12. Miao-Zhen Qiu1,2,
  13. Feng Wang1,2,
  14. Feng-Hua Wang1,2,
  15. Yu-Hong Li1,2,
  16. Xiao-Nan Wang5,
  17. Dan Xie1,
  18. Wei-Hua Jia1,
  19. Yang W Shao3,6,
  20. Rui-Hua Xu1,2
  1. 1 State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
  2. 2 Department of Medical Oncology, Sun Yat-sen University Cancer Center, Guangzhou, China
  3. 3 Translational Medicine Research Institute, Geneseeq Technology Inc., Toronto, Canada
  4. 4 Department of Molecular Diagnostics, Sun Yat-sen University Cancer Center, Guangzhou, China
  5. 5 Nanjing Geneseeq Technology Inc., Nanjing, China
  6. 6 School of Public Health, Nanjing Medical University, Nanjing, China
  1. Correspondence to Professor Rui-Hua Xu, Department of Medical Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China; xurh{at}


Objective To monitor trastuzumab resistance and determine the underlying mechanisms for the limited response rate and rapid emergence of resistance of HER2+ metastatic gastric cancer (mGC).

Design Targeted sequencing of 416 clinically relevant genes was performed in 78 paired plasma and tissue biopsy samples to determine plasma-tissue concordance. Then, we performed longitudinal analyses of 97 serial plasma samples collected from 24 patients who were HER2+  to track the resistance during trastuzumab treatment and validated the identified candidate resistance genes.

Results The results from targeted sequencing-based detection of somatic copy number alterations (SCNA) of HER2 gene were highly consistent with fluorescence in situ hybridisation data, and the detected HER2 SCNA was better than plasma carcinoembryonic antigen levels at predicting tumour shrinkage and progression. Furthermore, most patients with innate trastuzumab resistance presented high HER2 SCNA during progression compared with baseline, while HER2 SCNA decreased in patients with acquired resistance. PIK3CA mutations were significantly enriched in patients with innate resistance, and ERBB2/4 genes were the most mutated genes, accounting for trastuzumab resistance in six (35.3%) and five (29.4%) patients in baseline and progression plasma, respectively. Patients with PIK3CA/R1/C3 or ERBB2/4 mutations in the baseline plasma had significantly worse progression-free survival. Additionally, mutations in NF1 contributed to trastuzumab resistance, which was further confirmed through in vitro and in vivo studies, while combined HER2 and MEK/ERK blockade overcame trastuzumab resistance.

Conclusion Longitudinal circulating tumour DNA sequencing provides novel insights into gene alterations underlying trastuzumab resistance in HER2+mGC.

  • gastric cancer
  • HER2
  • trastuzumab resistance
  • ctDNA
  • next-generation sequencing
  • NF1

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • D-SW, Z-XL and Y-XL contributed equally.

  • Contributors Conception and design: D-SW, R-HX. Provision of study materials or patients: D-SW, Z-QW, M-ZQ, FW, F-HW, Y-HL, DX, W-HJ, R-HX. Collection and assembly of data: D-SW, Z-XL, Y-XL, HB, XW, Z-LZ, ZL, QZ, C-YH, J-HL, Z-QW, M-ZQ, FW, F-HW, Y-HL, X-NW, DX, W-HJ, YWS. In vitro and in vivo study: Y-XL, Z-LZ, C-YH, J-HL. Data analysis and interpretation: D-SW, Z-XL, HB, XW, ZL, QZ, X-NW, DX, W-HJ, YWS and R-HX. Manuscript writing: All authors. Final approval of manuscript: All authors. Accountable for all aspects of the work: All authors.

  • Funding (1) The National High Technology Research and Development Program of China (863 Program) (No. 2015AA020103); (2) The Natural Science Foundation of Guangdong Province (No. 2014A030312015), Science and Technology Program of Guangdong (No. 2015B020232008) and the Science and Technology Program of Guangzhou (Nos. 201508020250 and 201604020003); (3) The National Natural Science Foundation of China (Nos. 81602070 and 31501069); (4) The Major Special Project from Guangzhou Health and Medical Collaborative Innovation (No. 15570006); (5) Fundamental Research Funds for the Central Universities (SYSU: 16ykzd06) and (6) The National Key Research and Development Program of China (No. 2017YFC1308900).

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval The human research ethics committees at Sun Yat-sen University Cancer Center.

  • Provenance and peer review Not commissioned; externally peer reviewed.