Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
Gastric Cancer. 2020 Jul;23(4):579-590. doi: 10.1007/s10120-020-01039-7. Epub 2020 Jan 11.
Addition of trastuzumab to first-line palliative chemotherapy in gastroesophageal cancer patients with HER2 overexpression has shown to improve survival. Real-world data on HER2 assessment and administration of trastuzumab are lacking. The aim of this study was to assess HER2 testing, trastuzumab administration, and overall survival (OS) in a nationwide cohort of metastatic gastroesophageal cancer patients.
Data of patients with synchronous metastatic gastroesophageal adenocarcinoma diagnosed in 2010-2016 that received palliative systemic treatment (n = 2846) were collected from the Netherlands Cancer Registry and Dutch Pathology Registry. The ToGA trial criteria were used to determine HER2 overexpression. Proportions of HER2 tested patients were analyzed between hospital volume categories using Chi-square tests, and over time using trend analysis. OS was tested using the Kaplan Meier method with log rank test.
HER2 assessment increased annually, from 18% in 2010 to 88% in 2016 (P < 0.01). Median OS increased from 6.9 (2010-2013) to 7.9 months (2014-2016; P < 0.05). Between the hospitals, the proportion of tested patients varied between 29-100%, and was higher in high-volume hospitals (P < 0.01). Overall, 77% of the HER2 positive patients received trastuzumab. Median OS was higher in patients with positive (8.8 months) and negative (7.4 months) HER2 status, compared to non-tested patients (5.6 months; P < 0.05).
Increased determination of HER2 and administration of trastuzumab have changed daily practice management of metastatic gastroesophageal cancer patients receiving palliative systemic therapy, and possibly contributed to their improved survival. Further increase in awareness of HER2 testing and trastuzumab administration may improve quality of care and patient outcomes.
曲妥珠单抗联合一线姑息化疗治疗人表皮生长因子受体 2（HER2）过表达的胃食管交界癌患者可改善生存。目前缺乏关于 HER2 评估和曲妥珠单抗应用的真实世界数据。本研究旨在评估全国性转移性胃食管交界癌患者队列中 HER2 检测、曲妥珠单抗应用和总生存期（OS）。
收集 2010-2016 年诊断为同步转移性胃食管腺癌且接受姑息性全身治疗的患者数据（n=2846），来自荷兰癌症登记处和荷兰病理登记处。采用 ToGA 试验标准确定 HER2 过表达。使用卡方检验比较不同医院容量分类的 HER2 检测患者比例，并进行趋势分析。采用 Kaplan-Meier 方法和对数秩检验评估 OS。
HER2 评估逐年增加，从 2010 年的 18%增加到 2016 年的 88%（P<0.01）。中位 OS 从 2010-2013 年的 6.9 个月增加到 2014-2016 年的 7.9 个月（P<0.05）。各医院之间，检测患者的比例在 29%-100%之间，高容量医院的比例较高（P<0.01）。总体而言，77%的 HER2 阳性患者接受了曲妥珠单抗治疗。HER2 阳性（8.8 个月）和阴性（7.4 个月）患者的中位 OS 均高于未检测患者（5.6 个月；P<0.05）。
HER2 检测和曲妥珠单抗应用的增加改变了接受姑息性全身治疗的转移性胃食管交界癌患者的日常治疗管理，可能有助于提高他们的生存。进一步提高对 HER2 检测和曲妥珠单抗应用的认识可能会改善护理质量和患者结局。
