Role of human epidermal growth factor receptor 2 antagonist (Trastuzumab) in the management of nonmuscle-invasive urinary bladder carcinoma

Background: Superficial bladder cancers (nonmuscle invasive) are commonly faced by urologists and represent a major challenge for urologists and oncologists, especially Grade III carcinomas, whether conservative treatment is sufficient alone or with radical cystectomy is essential. Aim of the Study: We aimed to find a way to avoid recurrences in the nonmuscle-invasive bladder cancer and in the same time avoid radical cystectomy. Patient and Methods: We selected 42 patients with nonmuscle-invasive bladder cancers from those attending to Urology Department, Zagazig University Hospitals, from December 2011 to January 2015. After complete transurethral resection (TUR) bladder resection, diagnosis of biopsy was based on H and E-stained sections. Then, human epidermal growth factor receptor 2 (Her2) immunostaining was performed for all paraffin blocks derived from the patients. Trastuzumab was given to all cases that were positive to Her2, and only one case of them did not receive trastuzumab and left as a control. All cases then underwent follow-up for 20 months. Results: We found a significant relationship (P = 0.05) between Her2 immunostaining positivity and tumor stage, grade, multifocality, and recurrences/progression. Most cases who received trastuzumab did not undergo recurrences (19/22) (P = 0.005). We found also decrease in the immunostaining in cases of recurrences, indicating the presence of other factors affecting the occurrence or recurrences/progression. Conclusions: We concluded that administration of anti-Her2 therapy (like trastuzumab) may be essential for Her2-positive superficial bladder cancer to avoid recurrences after complete TUR bladder (TURB). Recommendation: We recommend for other studies on the significances of recurrences and how to avoid them.