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Case Report Open Access

Radical treatment for metastasis of HER2‑positive rectal adenocarcinoma to the liver: A case report and literature review

  • Authors:
    • Jiandi Huang
    • Zhiru Li
    • Dongwei He
    • Xin Li
    • Yaping Wang
    • Qingxia Li
    • Dongmiao Wang
    • Xiaoyan Fan
  • View Affiliations / Copyright

    Affiliations: Graduate School, Hebei North University, Zhangjiakou, Hebei 075132, P.R. China, Department of Oncology, Hebei General Hospital, Shijiazhuang, Hebei 050051, P.R. China, Laboratory of Pathology, Hebei Cancer Institute, The Fourth Hospital of Hebei Medical University, Shijiazhuang, Hebei 050010, P.R. China, Graduate School, Hebei Medical University, Shijiazhuang, Hebei 050011, P.R. China
    Copyright: © Huang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
  • Article Number: 408
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    Published online on: June 24, 2025
       https://doi.org/10.3892/ol.2025.15154
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Abstract

Human epidermal growth factor receptor 2 (HER2) positivity, including gene amplification and mutation, is uncommon in colorectal cancer (CRC), with an incidence of only ~5%. Targeted HER2 therapy has been shown to be feasible in patients with HER2‑positive CRC after the failure of standard treatments. However, the importance of anti‑HER2 therapy in patients with HER2‑positive CRC is not yet fully reflected in clinical guidelines. The present report describes the case of a 60‑year‑old female patient who presented with abdominal pain and bloody stools and was diagnosed with rectal adenocarcinoma and liver metastasis. The next‑generation sequencing of biopsy tissue obtained during colonoscopy suggested HER2 mutation/amplification. After two cycles of chemotherapy, the tumor marker levels of the patient continued to increase, indicating poor treatment efficacy. The patient subsequently received six cycles of chemotherapy combined with anti‑HER2 therapy, leading to a reduction in tumor marker levels and gradual shrinkage of the lesions. After this, the colorectal and liver lesions were surgically removed. There is currently no definitive treatment for HER2‑positive CRC. However, the present case highlights a favorable response to anti‑HER2 therapy in a patient with HER2‑positive metastatic CRC, suggesting that this treatment approach may be beneficial for HER2‑positive CRC and warrants further investigation.
View Figures

Figure 1

Initial assessment of the lesions by
computed tomography on October 15, 2023. (A-D) Metastatic liver
lesions: Slightly hypodense shadows are visible in the S2, S3 and
S4 segments of the liver, suggestive of metastasis. (E and F) Colon
lesions: Thickening of the sigmoid-rectal wall and enlargement of
the peripheral lymph nodes are indicative of malignancy. Lesions
are indicated by arrows.

Figure 2

Images captured during colonoscopy
performed on October 17, 2023.

Figure 3

Initial assessment of the liver
lesions by magnetic resonance imaging on October 20, 2023. (A-C)
Metastases in the S2, S3 and S4 segments and (D) two enlarged lymph
nodes, one anterior and one posterior to the portal vein are shown.
Lesions are indicated by arrows.

Figure 4

Changes in tumor markers during
treatment. Time course of the changes in (A) carcinoembryonic
antigen (normal level, <5.5 ng/ml), (B) carbohydrate antigen 242
(normal level, <6.9 U/ml) and (C) carbohydrate antigen 724
(normal level, <6.9 U/ml).

Figure 5

Lesions after 1 cycle of chemotherapy
as evaluated by computed tomography on November 10, 2023. (A-D)
Metastatic liver lesions: No marked change is visible compared with
those on October 15, 2023. (E and F) Colon lesions: Thickening of
the sigmoid-rectal wall is slightly less severe than that on
October 15, 2023, but no changes are evident in the surrounding
enlarged lymph nodes.

Figure 6

Lesions after 1 cycle of anti-HER2
therapy combined with chemotherapy as evaluated by computed
tomography on December 13, 2023. (A-D) Metastatic liver lesions:
Lesions appear smaller compared with those on November 10, 2023. (E
and F) Colon lesions: Thickening of the sigmoid-rectal wall is
reduced, and the enlarged surrounding lymph nodes are slightly
smaller than they were on November 10, 2023.

Figure 7

Lesions after 4 cycles of anti-HER2
therapy combined with chemotherapy as evaluated by computed
tomography on February 16, 2024. (A-D) Metastatic liver lesions:
Lesions are smaller compared with those on December 13, 2023. (E
and F) Colon lesions: Thickening of the sigmoid-rectal wall is
reduced and the surrounding lymph nodes are slightly smaller than
they were on December 13, 2023.

Figure 8

Metastatic liver lesions after 3
cycles of anti-HER2 therapy combined with chemotherapy as evaluated
by magnetic resonance imaging on January 25, 2024. (A-C) Metastases
in the S2, S3 and S4 segments of the liver are clearly reduced in
size compared with those on October 20, 2023. (D) The two lymph
nodes anterior and posterior to the portal vein are also less
enlarged.

Figure 9

Metastatic liver lesions after 6
cycles of anti-HER2 therapy combined with chemotherapy as assessed
by magnetic resonance imaging on April 10, 2024. When compared with
the images captured on January 25, 2024, (A-C) the larger
metastases in S2, S3 and S4 have decreased in size, while the
smaller metastasis appears unchanged. (D) No changes in the two
enlarged lymph nodes anterior and posterior to the portal vein are
evident.

Figure 10

Lesions 6 days after surgery as
assessed by computed tomography on April 25, 2024. Sites of
excision of the (A-D) metastatic liver lesions and (E) primary
colon lesion.

Figure 11

Lesions 3 weeks after surgery as
assessed by computed tomography on May 16, 2024. Sites of excision
of the (A-D) Metastatic liver lesions and (E) primary colon
lesion.

Figure 12

Computed tomography images acquired
on November 25, 2024, 1 year after the initiation of anti-HER2
therapy. Sites of excision of the (A-D) metastatic liver lesions
and (E) the primary colon lesion.

Figure 13

Timeline of treatment. PR, partial
response; CT, computed tomography; MRI, magnetic resonance imaging;
NGS, next-generation sequencing.
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Copy and paste a formatted citation
Spandidos Publications style
Huang J, Li Z, He D, Li X, Wang Y, Li Q, Wang D and Fan X: Radical treatment for metastasis of HER2‑positive rectal adenocarcinoma to the liver: A case report and literature review. Oncol Lett 30: 408, 2025.
APA
Huang, J., Li, Z., He, D., Li, X., Wang, Y., Li, Q. ... Fan, X. (2025). Radical treatment for metastasis of HER2‑positive rectal adenocarcinoma to the liver: A case report and literature review. Oncology Letters, 30, 408. https://doi.org/10.3892/ol.2025.15154
MLA
Huang, J., Li, Z., He, D., Li, X., Wang, Y., Li, Q., Wang, D., Fan, X."Radical treatment for metastasis of HER2‑positive rectal adenocarcinoma to the liver: A case report and literature review". Oncology Letters 30.3 (2025): 408.
Chicago
Huang, J., Li, Z., He, D., Li, X., Wang, Y., Li, Q., Wang, D., Fan, X."Radical treatment for metastasis of HER2‑positive rectal adenocarcinoma to the liver: A case report and literature review". Oncology Letters 30, no. 3 (2025): 408. https://doi.org/10.3892/ol.2025.15154
Copy and paste a formatted citation
x
Spandidos Publications style
Huang J, Li Z, He D, Li X, Wang Y, Li Q, Wang D and Fan X: Radical treatment for metastasis of HER2‑positive rectal adenocarcinoma to the liver: A case report and literature review. Oncol Lett 30: 408, 2025.
APA
Huang, J., Li, Z., He, D., Li, X., Wang, Y., Li, Q. ... Fan, X. (2025). Radical treatment for metastasis of HER2‑positive rectal adenocarcinoma to the liver: A case report and literature review. Oncology Letters, 30, 408. https://doi.org/10.3892/ol.2025.15154
MLA
Huang, J., Li, Z., He, D., Li, X., Wang, Y., Li, Q., Wang, D., Fan, X."Radical treatment for metastasis of HER2‑positive rectal adenocarcinoma to the liver: A case report and literature review". Oncology Letters 30.3 (2025): 408.
Chicago
Huang, J., Li, Z., He, D., Li, X., Wang, Y., Li, Q., Wang, D., Fan, X."Radical treatment for metastasis of HER2‑positive rectal adenocarcinoma to the liver: A case report and literature review". Oncology Letters 30, no. 3 (2025): 408. https://doi.org/10.3892/ol.2025.15154
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