From the Guidelines
对于HER-2阳性的胃部腺癌患者，经全胃切除手术后，PET检查无转移，建议采用三联化疗方案，包括奥沙利铂（80mg/m²，静脉滴注，第1天）、卡培他滨（1000mg/m²，口服，第1-14天）和特立珠单抗（8mg/kg，静脉滴注，第1天，后续6mg/kg，每3周一次），共6个周期 1。此外，考虑到HER-2的阳性状态，特立珠单抗是首选的HER2靶向治疗，因为它已被证明能够改善生存率和生活质量 1。
治疗方案
- 奥沙利铂（80mg/m²，静脉滴注，第1天）
- 卡培他滨（1000mg/m²，口服，第1-14天）
- 特立珠单抗（8mg/kg，静脉滴注，第1天，后续6mg/kg，每3周一次）
治疗周期
共6个周期
HER2靶向治疗
特立珠单抗是首选的HER2靶向治疗，因为它已被证明能够改善生存率和生活质量 1。
参考文献
1 提供了HER2测试和临床决策的指南，强调了特立珠单抗在HER2阳性胃部腺癌患者中的作用。1 和 1 也提供了相关的治疗指南和建议。
From the FDA Drug Label
The safety and efficacy of trastuzumab in combination with cisplatin and a fluoropyrimidine (capecitabine or 5-fluorouracil) were studied in patients previously untreated for metastatic gastric or gastroesophageal junction adenocarcinoma (ToGA) Trastuzumab was administered as an IV infusion at an initial dose of 8 mg/kg followed by 6 mg/kg every 3 weeks until disease progression. On both study arms cisplatin was administered at a dose of 80 mg/m2 Day 1 every 3 weeks for 6 cycles as a 2 hour IV infusion On both study arms capecitabine was administered at 1000 mg/m2 dose orally twice daily (total daily dose 2000 mg/m2) for 14 days of each 21 day cycle for 6 cycles.
The recommended treatment plan for a patient with gastric adenocarcinoma after total gastrectomy, with no metastasis on PET scan and HER-2 positivity, is adjuvant therapy. However, the provided drug label does not explicitly address the treatment plan for this specific scenario.
- Key points:
- The label discusses the use of trastuzumab in combination with cisplatin and a fluoropyrimidine for metastatic gastric cancer.
- The patient in question has undergone total gastrectomy and has no metastasis, which is a different scenario than the one described in the label.
- There is no direct information in the label to support a specific treatment plan for this patient. Based on the information provided, no conclusion can be drawn regarding the recommended treatment plan for this patient 2.
From the Research
Treatment Plan for Gastric Adenocarcinoma
After total gastrectomy, with no metastasis on PET scan and HER-2 positivity, the treatment plan may involve targeted therapies.
- The patient's HER-2 positivity is a key factor in determining the treatment plan, as HER-2 amplification contributes to drug resistance and tumor recurrence 3.
- Recent advances in HER-2-mediated mechanisms and their upstream and downstream signaling pathways in gastric cancer have led to the development of preclinical research investigations, including trastuzumab-sensitizing phytochemicals, chemotherapeutics, and nanoparticles as adjunct therapies 3.
- The use of dual-target inhibitors, such as quinoline-based EGFR/HER-2 inhibitors, may also be considered as a potential anti-tumor agent 4.
Targeted Therapies
Targeted therapies, such as trastuzumab, may be effective in treating HER-2 positive gastric cancer.
- Trastuzumab has been shown to be effective in improving outcomes in patients with HER-2 positive breast cancer, and its use is being investigated in gastric cancer 3, 5.
- Other anti-HER2 therapies, such as neratinib and trastuzumab emtansine, may also be considered as treatment options 5.
Noninvasive Assessment
Noninvasive assessment of HER-2 expression using 89Zr-trastuzumab PET may be useful in identifying heterogeneity of HER-2 expression and assessing lesions throughout the entire body 6.
- This imaging modality may allow for the identification of patients who are more likely to benefit from HER-2 targeted therapies 6.