Gastrointestinal Oncology Service, Memorial Sloan Kettering Cancer Center, Weill-Cornell Medical College, New York, New York, USA.
Curr Opin Gastroenterol. 2020 Nov;36(6):525-529. doi: 10.1097/MOG.0000000000000679.
To provide an up-to-date review on the management of cancers of the stomach and esophagogastric junction (EGJ).
Microsatellite instable (MSI) high status in gastric cancer may portend a relatively good prognosis and indicate that adjuvant chemotherapy is of no added benefit to primary surgical management. In the preoperative treatment of HER2 (ErbB2)-positive EGJ adenocarcinoma with chemoradiotherapy, the addition of trastuzumab, a recombinant humanized mAb directed against the extracellular domain of Her2, failed to improve outcome over conventional chemoradiotherapy alone. Escalating the dose of radiation in combined chemoradiotherapy regimens did not improve survival over conventional dose radiotherapy in the nonoperative management of EGJ cancer. The use of proton vs. conventional external beam radiation therapy, although potentially less toxic, did not improve therapy outcome with preoperative or definitive chemoradiotherapy in EGJ cancer. In metastatic HER2-positive gastric cancer, after disease progression on trastuzumab, continuation of trastuzumab did not improve progression free or overall survival compared with second-line chemotherapy alone. However, in the setting or prior trastuzumab therapy in metastatic HER2-positive gastric cancer, the new agent trastuzumab deruxtecan achieved significant rates of response, progression free and overall survival compared with standard chemotherapy. After initial chemotherapy for metastatic esophagogastric cancer, maintenance therapy with the anti PDL-1 agent avelumab was no better than chemotherapy alone.
MSI high gastric cancer has a better prognosis and may not require adjuvant chemotherapy. Trastuzumab, added to preoperative chemoradiotherapy in HER2-positive esophageal adenocarcinoma, does not improve outcome. Dose escalation of radiotherapy in the nonoperative management of EGJ cancer does not improve local control or survival, and proton therapy may not achieve superior outcomes compared with external beam radiotherapy. In metastatic HER2-positive gastric cancer, continuing trastuzumab into second-line chemotherapy does not add benefit; however, the novel agent trastuzumab deruxtecan has substantial activity after prior trastuzumab-based therapy.
提供最新的胃癌和胃食管交界处（EGJ）癌症的治疗管理。
胃癌的微卫星不稳定（MSI）高状态可能预示着相对较好的预后，并表明辅助化疗对主要手术治疗没有额外的益处。在术前用放化疗治疗 HER2（ErbB2）阳性的 EGJ 腺癌时，添加曲妥珠单抗，一种针对 Her2 细胞外结构域的重组人源化单克隆抗体，未能改善单纯常规放化疗的疗效。在 EGJ 癌的非手术治疗中，增加联合放化疗方案中的放疗剂量并没有改善常规剂量放疗的生存率。与常规外照射放疗相比，质子放疗虽然潜在毒性较小，但在术前或确定性放化疗治疗 EGJ 癌中并未改善治疗效果。在转移性 HER2 阳性胃癌中，曲妥珠单抗治疗进展后，继续使用曲妥珠单抗治疗并不比单独二线化疗改善无进展生存期或总生存期。然而，在转移性 HER2 阳性胃癌中曲妥珠单抗治疗后，新型药物曲妥珠单抗 deruxtecan 与标准化疗相比，具有显著的缓解率、无进展生存期和总生存期。在转移性胃食管交界癌初始化疗后，用抗 PD-L1 药物avelumab 进行维持治疗并不优于单独化疗。
MSI 高胃癌预后较好，可能不需要辅助化疗。在 HER2 阳性食管腺癌中，曲妥珠单抗联合术前放化疗并不能改善疗效。在 EGJ 癌的非手术治疗中增加放疗剂量并不能提高局部控制率或生存率，质子治疗可能并不优于外照射放疗。在转移性 HER2 阳性胃癌中，将曲妥珠单抗继续用于二线化疗并不能带来获益；然而，新型药物曲妥珠单抗 deruxtecan 在曲妥珠单抗治疗后具有显著的疗效。
