From the Guidelines
对于全胃切除后的胃部腺癌患者，PET检查未显示转移，病理报告显示中分化腺癌，肌层浸润，HER-2阳性，建议采用辅助化疗方案，如奥沙利铂（oxaliplatin）100mg/m²，联合氟尿嘧啶（5-fluorouracil）400mg/m²静脉注射，连续静脉输注为2400mg/m²，共6个周期。同时，考虑到HER-2阳性，建议添加曲妥珠单抗（trastuzumab）8mg/kg静脉注射，作为首次剂量，随后每3周6mg/kg，共1年 1。
治疗方案
- 辅助化疗：奥沙利铂（oxaliplatin）100mg/m²，联合氟尿嘧啶（5-fluorouracil）400mg/m²静脉注射，连续静脉输注为2400mg/m²，共6个周期
- HER-2靶向治疗：曲妥珠单抗（trastuzumab）8mg/kg静脉注射，作为首次剂量，随后每3周6mg/kg，共1年
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注意事项
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 moderately differentiated gastric adenocarcinoma, muscularis layer invasion, and HER-2 positivity after total gastrectomy and a PET scan showing no metastasis is adjuvant chemotherapy.
- Trastuzumab in combination with cisplatin and a fluoropyrimidine (such as capecitabine or 5-fluorouracil) may be considered as part of the treatment plan, based on the ToGA study results 2.
- The treatment plan should be individualized and based on the patient's specific clinical characteristics and needs.
- It is essential to note that the ToGA study was conducted in patients with metastatic gastric cancer, and the results may not be directly applicable to patients with non-metastatic disease.
- However, given the HER-2 positivity of the tumor, trastuzumab may be a valuable component of the treatment plan.
From the Research
Treatment Plan for Moderately Differentiated Gastric Adenocarcinoma
The patient has moderately differentiated gastric adenocarcinoma with muscularis layer invasion and HER-2 positivity after total gastrectomy, and a PET scan showing no metastasis.
- The treatment plan may involve perioperative chemotherapy with a regimen such as 5-fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) in combination with trastuzumab, as studied in 3.
- Trastuzumab has been shown to improve survival when added to chemotherapy in patients with HER-2-positive metastatic esophagogastric adenocarcinoma.
- Another option could be the use of S-1 plus oxaliplatin (SOX) therapy, which has been shown to be effective in advanced gastric cancer, as reported in 4 and 5.
- The efficacy and safety of camrelizumab combined with oxaliplatin and S-1 as neoadjuvant treatment in locally advanced gastric or gastroesophageal junction cancer has also been evaluated, as seen in 6.
- Preoperative chemotherapy with docetaxel, oxaliplatin, and S-1 (DOS) has shown promising efficacy and acceptable feasibility for resectable advanced gastric cancer, as mentioned in 7.
Key Considerations
- The patient's HER-2 positivity is a key factor in determining the treatment plan, as trastuzumab has been shown to be effective in combination with chemotherapy in HER-2-positive patients.
- The absence of metastasis on the PET scan suggests that the patient may be a candidate for curative surgery, and neoadjuvant chemotherapy may be considered to improve outcomes.
- The choice of chemotherapy regimen will depend on various factors, including the patient's overall health, tumor characteristics, and potential side effects of treatment.