Vakiani Efsevia
Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY.
Adv Anat Pathol. 2015 May;22(3):194-201. doi: 10.1097/PAP.0000000000000067.
The human epidermal growth factor receptor 2 (HER2) is overexpressed in 10% to 35% of gastric and gastroesophageal junction (GEJ) adenocarcinomas. In 2010, the phase III Trastuzumab for Gastric Cancer (ToGA) trial showed that addition of the anti-HER2 monoclonal antibody trastuzumab to chemotherapy significantly improved survival of patients with advanced or metastatic tumors that were positive for HER2 overexpression. As a result, HER2 testing is now recommended for all patients with advanced or metastatic disease, although there is still some debate as to the optimal methods of assessment. HER2 expression in gastric and GEJ tumors shows several differences compared with breast tumors and, for this reason, the proposed criteria for scoring HER2 expression in biopsies and resections of gastric and GEJ carcinomas differ from those used in breast carcinomas. This review discusses what is currently known about the patterns of HER2 expression in gastric and GEJ adenocarcinomas, summarizes the findings of the ToGA trial and its clinical implications, and provides an overview of the recommended guidelines for the most accurate evaluation of HER2 status in gastric and GEJ cancer.
人表皮生长因子受体2（HER2）在10%至35%的胃癌和胃食管交界（GEJ）腺癌中过表达。2010年，III期胃癌曲妥珠单抗治疗（ToGA）试验表明，在化疗中添加抗HER2单克隆抗体曲妥珠单抗可显著提高HER2过表达阳性的晚期或转移性肿瘤患者的生存率。因此，现在建议对所有晚期或转移性疾病患者进行HER2检测，尽管对于最佳评估方法仍存在一些争议。与乳腺肿瘤相比，胃和GEJ肿瘤中的HER2表达存在一些差异，因此，在胃和GEJ癌活检及切除标本中HER2表达评分的建议标准与乳腺癌中使用的标准不同。本综述讨论了目前已知的胃和GEJ腺癌中HER2表达模式，总结了ToGA试验的结果及其临床意义，并概述了用于最准确评估胃和GEJ癌中HER2状态的推荐指南。
