Negative Discordance (HER2)

Yes, I've seen many who have changes in their PDL1 expression and HER2-Positivity... either in a recurrence after neoadjuvant treatments and surgery... or in mets that were biopsied down the road.

But as to how and when certain immunotherapies are then applied... maybe there's a rhyme and reason... maybe not. But there are a couple of considerations. One... will your oncologist (or tumor board) recommend a certain immunotherapy without threshold values (even if your tumor used to meet these values), and two, will insurance agree to cover these costs. I've seen examples of each... as well as examples of certain immunotherapies working well for the patient in cases where they had no business being effective.

This does not apply to me personally as I did a year of adjuvant Opdivo with no PDL1 expression. But these days, this is common for stage 3's who also did chemo and radiation and went to surgery.

Gary

Welcome, @jeh10. I'm tagging a few members who have experience with HER-2 positive esophageal cancer like @jane59 @jmp1514 @nuggetofmine and others.

Jeh, can you tell me a bit more about the negative discordance? What your original tumor HER-2 postive but the mestastasis HER-2 negative? Which treatment is being suggested for you?

Thanks for the response! I am asking on behalf of a close family member.

The original tumor was HER2+, but the biopsy of one metastasis (he has several) was HER2-. Now his oncologist reports that he can’t receive any HER2+ treatments, including ENHERTU which was the original plan. The new plan is still to be determined.