Background: Of the cancers diagnosed in Rwanda, stomach cancer is one of the most encountered. In fact, Rwanda belongs to the region where it is most incident in Africa. Most of the patients present with advanced disease. Studies showed that some gastric cancers overexpress Human Epidermal Growth Factor Receptor 2 (HER2/neu) protein and can be treated with Herceptin/Tras-tuzumab. This targeted therapy improves survival in patients with advanced disease. We conducted a study on Immunohistochemical profile of HER2/neu in gastric adenocarcinomas at two main Rwandan tertiary centers. Methodology: We tested for HER2/NEU in gastric adenocarcinomas diagnosed at University Teaching Hospital of Kigali (CHUK) and University Teaching Hospital of Butare (CHUB). Demographic and pathologic parameters were collected. Immunohistochemistry (IHC) for HER2/neu using c-erb/HER-2/neu (clone SP3) Rabbit Monoclonal antibody was done. Using the guidelines established by Hoffman et al. , the agreed score between 2 Rwandan pathologists and 1 USA pathologist was considered each time. Data were entered and statistically analyzed using SPSS 22. Descriptive statistical analysis method was used. P-value calculated with Chi-square analysis for positive vs negative and equivocal negative to correlate HER2/neu overexpression with other variables across both hospitals. Results: A total of 286 cases were tested. HER2/neu overexpression (score 3+ or positive) was found in 29 cases (10.1%). 8 cases (2.8%) were equivocal negative (score 2+) while 249 cases (87.1%) were negative (score 0 and 1+). Conclusion: HER2/neu is overexpressed in a subset of gastric cancers in Rwanda, a phenomenon that has been reported in other areas of the world. Testing for HER2/neu could identify patients who would get a targeted treatment with Herceptin.
Karimi, P., Islami, F., Anandasabapathy, S., Freedman, N.D. and Kamangar, F. (2014) Gastric Cancer: Descriptive Epidemiology, Risk Factors, Screening, and Prevention. Cancer Epidemiology, Biomarkers & Prevention, 23, 700-714. https://doi.org/10.1158/1055-9965.EPI-13-1057
Herszényi, L. and Tulassay, Z. (2010) Epidemiology of Gastrointestinal and Liver Tumors. European Review for Medical and Pharmacological Sciences, 14, 249-258.
Ahmed, A., Ukwenya, A.Y., Makama, J.G. and Mohammad, I. (2011) Management and Outcome of Gastric Carcinoma in Zaria, Nigeria. African Health Sciences, 11, 353-361.
Asombang, A.W., Rahman, R., Ibdah, J.A., Asombang, A.W., Rahman, R. and Ibdah, J.A. (2014) Gastric Cancer in Africa: Current Management and Outcomes. World Journal of Gastroenterology, 20, 3875-3879. https://doi.org/10.3748/wjg.v20.i14.3875
Newton, R., Ngilimana, P.-J., Grulich, A, et al. (1996) Cancer in Rwanda. International Journal of Cancer, 66, 75-81. https://doi.org/10.1002/(SICI)1097-0215(19960328)66:1 3.0.CO;2-A
Shikama, F., Bensen, S.P., Giraneza, R., Hategekimana, E., et al. (2022) Upper Gastrointestinal Cancers in Rwanda: Epidemiological, Clinical and Histopathological Features in Patients Presenting to a Tertiary Referral Hospital. Open Journal of Gastroenterology, 12, 286-298. https://doi.org/10.4236/ojgas.2022.1210029
Ntakiyiruta, G. (2009) Gastric Cancer at Kibogora. East and Central African Journal of Surgery, 14, 130-134.
Li, Y.M., Feng, A.Z., Zheng, S., et al. (2022) Recent Estimates and Predictions of 5-Year Survival in Patients with Gastric Cancer: A Model-Based Period Analysis. Original Research Article, 29, 1-9. https://doi.org/10.1177/10732748221099227 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9067041/pdf/10.1177_10732748221099227.pdf
Yoon, D.H. (2011) Results and Implications of the Trastuzumab for Gastric Cancer (ToGA) Trial. Journal of Clinical Investigation, 1, 87-95. https://doi.org/10.4155/cli.10.5
Mary, D. (2017) Chamberlin, Belson Rugwizangoga, Francine B DeAbreu et al. Feasibility Study of Molecular Profiling of Gastric cancer specimens from Rwanda. Journal of Global Oncology, 3, 44. https://doi.org/10.1200/JGO.2017.009605 https://ascopubs.org/doi/abs/10.1200/JGO.2017.009605
Maresch, J., Schoppmann, S.F., Thallinger, C.M.R., Zielinski, C.C. and Hejna, M. (2012) Her-2/Neu Gene Amplification and Over-Expression in Stomach and Esophageal Adenocarcinoma: From Pathology to Treatment. Critical Reviews in Oncology/Hematology, 82, 310-322. https://doi.org/10.1016/j.critrevonc.2011.06.003
Ali Hussein, A., Rogena, E., Omulo, T.M. and Ndaguatha, P.L.W. (2014) HER2/Neu Protein Over-Expression in Patients with Gastric and Gastro-Esophageal Junction Carcinoma Seen at Kenyatta National Hospital, Kenya. Journal of Carcinogenesis & Mutagenesis, 5, Article No. 186.
Zhou, Z. and Hick, D.G. (2013) HER2 Amplification or Overexpression in Upper GI Tract and Breast Cancer with Clinical Diagnosis and Treatment. In: Siregar, Y., Ed., Oncogene and Cancer: From Bench to Clinic, IntechOpen, London. https://doi.org/10.5772/53921
Abrahao-Machado, L.F., Scapulatempo-Neto, C., Abrahao-Machado, L.F. and Scapulatempo, C. (2016) Global View HER2 Testing in Gastric Cance: An Update. World Journal of Gastroenterology, 22, 4619-4625. https://doi.org/10.3748/wjg.v22.i19.4619
Orditura, M., Galizia, G., Sforza, V., Gambardella, V., Fabozzi, A., Laterza, M.M., et al. (2014) Treatment of Gastric Cancer. World Journal of Gastroenterology, 20, 1635-1649. https://doi.org/10.3748/wjg.v20.i7.1635
Taboada, S. and Whitney-Miller, C.L. (2013) Updates in HER2 Testing in Gastric Cancer. Journal of Gastrointestinal & Digestive System, 3, Article No. 131. https://doi.org/10.4172/2161-069X.1000131
Rajagopal, I., Niveditha, S.R., Sahadev, R., Nagappa, P.K. and Goddanakoppal, S. (2015) HER 2 Expression in Gastric and Gastro-Esophageal Junction (GEJ) Adenocarcinomas. Journal of Clinical and Diagnostic Research, 9, 6-10. https://doi.org/10.7860/JCDR/2015/12581.5630
Roberts, R., Govender, P., Naidoo, R. and Locketz, M. (2016) A Morphological and Immunohistochemical Evaluation of Gastric Carcinoma in the Western Cape Province of South Africa. South African Journal of Surgery, 54, 15-21
Hechtman, J.F. and Polydorides, A.D. (2012) HER2/Neu Gene Amplification and Protein Overexpression in Gastric and Gastroesophageal Junction Adenocarcinoma: A Review of Histopathology, Diagnostic Testing, and Clinical Implications. Archives of Pathology & Laboratory Medicine, 136, 691-697. https://doi.org/10.5858/arpa.2011-0168-RS
Janjigian, Y.Y., Werner, D., Pauligk, C., Steinmetz, K., Kelsen, D.P., Jäger, E., et al. (2012) Prognosis of Metastatic Gastric and Gastroesophageal Junction Cancer by HER2 Status: A European and USA International Collaborative Analysis. Annals of Oncology, 23, 2656-2662. https://doi.org/10.1093/annonc/mds104
Grabsch, H., Sivakumar, S., Gray, S., Gabbert, H.E., Müller, W., Pathology, M., et al. (2010) HER2 Expression in Gastric Cancer: Rare, Heterogeneous and of No Prognostic Value—Conclusions from 924 Cases of Two Independent Series. Analytical Cellular Pathology, 32, 57-65. https://doi.org/10.1155/2010/519498
Allgayer, H., Babic, R., Gruetzner, K.U., Tarabichi, A., Schildberg, F.W. and Heiss, M.M. (2000) C-erbB-2 Is of Independent Prognostic Relevance in Gastric Cancer and Is Associated with the Expression of Tumor-Associated Protease Systems. Journal of Clinical Oncology, 18, 2201-2209. https://doi.org/10.1200/JCO.2000.18.11.2201
Patil, P.S., Mehta, S.A. and Mohandas, K.M. (2013) Over-Expression of HER2 in Indian Patients with Gastric Cancer. Indian Journal of Gastroenterology, 32, Article No. 350. https://doi.org/10.1007/s12664-012-0279-9
Jørgensen, J.T. and Hersom, M. (2012) HER2 as a Prognostic Marker in Gastric Cancer—A Systematic Analysis of Data from the Literature. Journal of Caner, 3, 137-144. https://doi.org/10.7150/jca.4090
Laboissiere, R.S., Buzelin, M.A., Balabram, D., De Brot, M. Nunes, C.B., Rocha, R.M., et al. (2015) Association between HER2 Status in Gastric Cancer and Clinicopathological Features: A Retrospective Study Using Whole-Tissue Sections. BMC Gastroenterology, 15, Article No. 157. https://doi.org/10.1186/s12876-015-0384-1
Xie, S.D., Xu, C.Y., Shen, J.G., Jiang, Z.N., Shen, J.Y. and Wang, L.B. (2009) HER 2/Neu Protein Expression in Gastric Cancer Is Associated with Poor Survival. Molecular Medicine Reports, 2, 943-946.