Figure 4.

Patient with ampullary carcinoma and ERBB2 amplification treated with anti‐human epidermal growth receptor 2 therapy (trastuzumab and pertuzumab). A 68‐year‐old woman with ampullary carcinoma presented with recurrent disease to lung 5 years after the completion of perioperative therapy with neoadjuvant chemotherapy (5‐fluorouracil, irinotecan, and oxaliplatin) followed by Whipple procedure and adjuvant 5‐ fluorouracil. Biopsy of lung mass confirmed metastatic ampullary carcinoma. Tissue next‐generation sequencing revealed alterations, including ERBB2 amplification. Patient received trastuzumab and pertuzumab, demonstrating partial response. Left: Computerized axial tomography (CAT) scan of chest before treatment. Right: CAT scan 14 months after the treatment, showing about 59% reduction in size of lung mass (per Response Evaluation Criteria in Solid Tumors, version 1.1). Progression‐free survival = 15.2+ months (supplemental online Table 1, ID #1).