Rutika J. Mehta, MD, MPH, a medical oncologist specializing in gastrointestinal cancer at Moffitt Cancer Center, discusses the ​current treatment paradigm in HER2-positive gastric cancer. 

Unlike the HER2-positive breast cancer space, patients with HER2-positive gastric cancer have limited treatment options, says Mehta.

Moreover, since there are no data supporting the continuation of ​trastuzumab (Herceptin) after disease progression, the field is ​working to​ identify the mechanism of resistance to trastuzumab, Mehta explains. 

Additionally, HER2-positive gastric cancer tends to be more heterogeneous compared with HER2-positive breast cancer, which poses the question of whether lesion-specific biopsies are representative of the entire disease. As such, the optimal role of trastuzumab and other anti–HER2-based regimens remain largely unknown in this space, Mehta concludes.

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Rutika J. Mehta, MD, MPH, discusses the ​current treatment paradigm in HER2-positive gastric cancer. 

Dr. Mehta on the Current Treatment Paradigm in HER2-Positive Gastric Cancer 

Rutika J. Mehta, MD, MPH, a medical oncologist specializing in gastrointestinal cancer at Moffitt Cancer Center, discusses the role of biomarkers in gastric cancer.

Biomarkers such as microsatellite instability, mismatch repair ​deficiency, HER2 status, PD-L1 ​status, and tumor mutational burden are of interest in the gastric cancer space, says Mehta.

​Moreover, according to Mehta, all patients ​with metastatic disease should be ​molecularly profiled. 

​Additionally, if tissue is available, ordering next​-generation sequencing may be beneficial ​in terms of treatment selection and identifying available clinical trials, Mehta concludes. 

Rutika J. Mehta, MD, MPH, discusses the role of biomarkers in gastric cancer.

Dr. Mehta on the Role of Biomarkers in Gastric Cancer 

Rutika J. Mehta, MD, MPH, a medical oncologist specializing in gastrointestinal cancer at Moffitt Cancer Center, discusses how treatment has evolved in recent years for gastric and gastroesophageal junction (GEJ) cancers.

Depending on which institution a patient goes to, GEJ cancers can be treated similarly to esophageal or gastric cancers, says Mehta. There are 2 schools of thought on this, but GEJ cancers and gastric cancers are commonly grouped together for clinical trial purposes, says Mehta.

In the locally advanced setting, the standard has always been perioperativechemotherapy. Until a few years ago, the standard approach was epirubicin-based treatment with 3 cycles given preoperatively and 3 cycles given postoperatively; this is commonly referred to as a “sandwich”approach, notes Mehta.

The combination of 5-fluorouracil, leucovorin, oxaliplatin, and docetaxel has become the new standard of care in recent years, surpassing the median overall survival benefit we had previously seen, while eliciting impressive pathologic complete response rates, as well, adds Mehta.

Thus, epirubicin-based therapy should now be reserved for patients with locally advanced gastric cancer who are otherwise candidates for surgery, concludes Mehta.

Rutika J. Mehta, MD, MPH, discusses how treatment has evolved in recent years for gastric and gastroesophageal junction cancers.

Rutika J. Mehta, MD, MPH

Articles

Dr. Mehta on the Current Treatment Paradigm in HER2-Positive Gastric Cancer

Dr. Mehta on the Role of Biomarkers in Gastric Cancer

Dr. Mehta on the Evolution of Treatment in Gastric and GEJ Cancers