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The study uses a four-part regimen that integrates a novel anti-HER2 antibody (RC48) with a PD-1 inhibitor, radiotherapy, and granulocyte macrophage-colony stimulating factor (GM-CSF), following a PRaG approach. After rapid progression on prior surgery and multiple trastuzumab plus chemotherapy courses, the patient showed a positive response after two treatment cycles and achieved a progression-free survival of 6.5 months, supporting the potential of four-combination strategies and the importance of carefully selected radiation dosing for dual-target immunotherapy.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/combination-treatment-with-anti-her2-therapeutic-antibody-rc48-pd-1-inhibitor-radiotherapy-and-granulocyte-macrophage-colony-stimulating-factor-gmcsf-in-patient-with-metastatic-gastric-cancer-a-case-report/337473/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/combination-treatment-with-anti-her2-therapeutic-antibody-rc48-pd-1-inhibitor-radiotherapy-and-granulocyte-macrophage-colony-stimulating-factor-gmcsf-in-patient-with-metastatic-gastric-cancer-a-case-report/337473.png","ImageObject",300,407,{"name":92,"@type":93},"Patrick","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-21",true,{"@type":102,"interactionType":103,"userInteractionCount":29},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What treatment combination is used in this case report?","Question",{"text":112,"@type":113},"The case report describes a four-combination strategy using anti-HER2 antibody RC48 together with a PD-1 inhibitor, radiotherapy, and GM-CSF within a PRaG regimen framework.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"Why was this regimen chosen for the patient?",{"text":117,"@type":113},"The patient had HER2-positive and PD-L1-negative metastatic gastric adenocarcinoma with rapid progression after surgery and multiple trastuzumab plus chemotherapy treatments, and options were limited after conventional approaches.",{"name":119,"@type":110,"acceptedAnswer":120},"What outcomes were reported after RC48 plus the PRaG-based regimen?",{"text":121,"@type":113},"After two treatment cycles the patient demonstrated a positive response, with a progression-free survival time of 6.5 months.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},337473,1790914687,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":29,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":52,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144},549758146520,"https://ap-avatar.wpscdn.com/avatar/80002397d8c0411e94?_k=1775819394049821470","TYPE Case Report  \nPUBLISHED 01 February 2024  \nDOI 10.3389/fimmu.2024.1321946  \nOPEN ACCESS  \nEDITED BY  \nYih-Horng Shiao,  \nUnited States Patent and Trademark Office, United States  \nREVIEWED BY Liyuan Zhang,  \nSecond Affiliated Hospital of Soochow University, China  \nAmin Nassar,  \nYale New Haven Health System, United States  \n*CORRESPONDENCE Yang Yang  \n [doctoryang1985@163.com](doctoryang1985@163.com)  \n†These authors have contributed equally to this work and share first authorship  \nRECEIVED 15 October 2023  \nACCEPTED 19 January 2024  \nPUBLISHED 01 February 2024  \nCITATION  \nLiu Z, Wang F, Zhang Y, Lu J and Yang Y (2024) Combination treatment with antiHER2 therapeutic antibody RC48, PD-1 inhibitor, radiotherapy, and granulocyte macrophage-colony stimulating factor (GMCSF) in patient with metastatic gastric cancer: a case report.  \nFront. Immunol. 15:1321946 .  \ndoi: 10.3389/fimmu.2024.1321946  \nCOPYRIGHT  \n© 2024 Liu, Wang, Zhang, Lu and Yang. This isan open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.  \nCombination treatment  \nwith anti-HER2 therapeutic antibody RC48, PD-1 inhibitor, radiotherapy, and granulocyte macrophage-colony stimulating factor (GM-CSF) in patient with metastatic gastric cancer: a case report  \nZhuixing Liu 1†, Fang Wang2†, Yingqi Zhang 2, Jun Lu 2 and Yang Yang 2*  \n1 Department of Oncology, Xi‘an International Medical Center Hospital, Xi ‘an, China, 2 Department of Radiotherapy & Oncology, Xi‘an International Medical Center Hospital, Xi‘an, China  \nHER2 overexpression/amplification is a prevalent driver in various types of cancer, including gastric cancer (GC) . Limited options are available for patients with HER2-positive metastatic gastric cancer, particularly those who do not respond to the standard therapy of HER2 antibody trastuzumab combined with chemotherapy. Previous research suggests that combining a PD-1 inhibitor with radiotherapy and granulocyte macrophage-colony stimulating factor (PRaG regimen) may enhance the antitumor effects in patients with chemotherapyresistant metastatic solid tumors. In this case study, we presented a potential treatment strategy of a patient having HER2-positive and PD-L1-negative gastric adenocarcinoma. The patient showed rapid tumor progression even after surgery and multiple trastuzumab plus chemotherapy treatments. To address this, we employed a novel anti-HER2 antibody called RC48 in combination with PRaG regimen therapy (PRaG3 . 0) . The patient demonstrated a positive response after two treatment cycles and achieved a progression-free survival time of 6.5 months. This case highlights the potential of four-combination therapies for treating refractory, multiorgan, HER2-positive, PD-L1-negative metastatic gastric cancer. Additionally, varying radiation doses in targeting dual foci is critical to enhance tumor immunotherapy.  \nKEYWORDS  \nRC48, PD-1 inhibitor, stereotactic body radiotherapy, GM-CSF, gastric cancer, HER2-positive  \nFrontiers in Immunology 01 [frontiersin.org](frontiersin.org)  \n1 Introduction  \nAccording to the findings from Global Cancer Statistics 2020, gastric cancer (GC) is the fifth most commonly diagnosed cancer and the fourth leading cause of cancer-related deaths worldwide (1) . In China, there are over 20,000 new cases of GC each year, with approximately 170,000 deaths attributed to this disease, accounting for about 25% of all cancer-related deaths (2) . Around 20% of GC patients show an overexpression of human epidermal growth factor receptor 2(HER2) (3) . The phase III ToGA trial has confirmedtrastuzumab as the approved medication to be included in the ","cbCaicCiQDiPgSSs","https://ap.wps.com/l/cbCaicCiQDiPgSSs","pdf",1394186,"English","# Introduction\n## HER2-positive metastatic gastric cancer background and limitations of standard therapy\n## Immunotherapy with PD-1/PD-L1 inhibitors in metastatic gastric cancer\n## Role of radiotherapy and stereotactic body radiotherapy (SBRT) in immune activation\n## Study rationale for combining RC48, PRaG regimen, and radiation strategies","[{\"question\":\"What treatment combination is used in this case report?\",\"answer\":\"The case report describes a four-combination strategy using anti-HER2 antibody RC48 together with a PD-1 inhibitor, radiotherapy, and GM-CSF within a PRaG regimen framework.\"},{\"question\":\"Why was this regimen chosen for the patient?\",\"answer\":\"The patient had HER2-positive and PD-L1-negative metastatic gastric adenocarcinoma with rapid progression after surgery and multiple trastuzumab plus chemotherapy treatments, and options were limited after conventional approaches.\"},{\"question\":\"What outcomes were reported after RC48 plus the PRaG-based regimen?\",\"answer\":\"After two treatment cycles the patient demonstrated a positive response, with a progression-free survival time of 6.5 months.\"}]","Combination treatment with anti-HER2 therapeutic antibody RC48, PD-1 inhibitor, radiotherapy, and granulocyte macrophage-colony stimulating factor (GMCSF) in patient with metastatic gastric cancer - a case report | PDF",1790019267,25]