Sheng et al. present “” via https://bit.ly/4spB5XM (Original research, GI cancer section).
Why do targeted therapies stop working? Using spatial transcriptomics, this study reveals how tumour heterogeneity, immune escape and metabolic shifts drive resistance in HER2-positive gastric cancer. A must-read for anyone interested in precision oncology and treatment optimisation.
Background Human epidermal growth factor receptor 2 (HER2; ERBB2) is overexpressed or amplified in 15–20% of gastric cancers (HER2+ GC). Within individual HER2+ GCs, HER2/ ERBB2 expression is often variable. Although HER2 therapeutic targeting improves outcomes for HER2+ GC patients, acquired resistance is frequent.
Objective To spatially interrogate HER2+ GC interpatient and intrapatient heterogeneity and resistance mechanisms associated with HER2-targeting agents (trastuzumab, trastuzumab deruxtecan (T-DXd)).
Design Spatial transcriptomic analysis (GeoMx Digital Spatial Profiler) was applied to 1,500 regions of interest in 30 GCs—these contained 15 HER2+ GCs treated with trastuzumab and T-DXd subsequently. Analysis of patient-matched samples with acquired trastuzumab or T-DXd resistance revealed escape mechanisms.








