Department of Oncology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine.
National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, People's Republic of China.
Anticancer Drugs. 2021 Aug 1;32(7):675-680. doi: 10.1097/CAD.0000000000001081.
Human epidermal growth-factor receptor 2 (HER2) was an important therapeutic target in gastric cancer. Through the last decade, strategy with trastuzumab-based chemotherapy remains the first-line standard of treatment in advanced HER2-positive gastric cancer. Based on the Trastuzumab for Gastric Cancer trial, trastuzumab plus systemic chemotherapy of cisplatin and fluoropyrimidine as the backbone was established as the first-line therapy in advanced HER2-positive gastric cancer. Since then, studies have explored the optimization of the front-line strategy, including the dose of trastuzumab, chemotherapy regimen and maintenance therapy. A large number of clinical trials were conducted to explore the optimal front-line therapy regimens, such as lapatinib and pertuzumab. Safe and effective first-line regimens are still lacking. Recently, two phase II studies of combining immune checkpoint inhibitor in first-line treatment of advanced HER2-positive gastric cancer showed promising results. The progress of immunotherapy has gradually promoted the development of front-line treatment of advanced HER2-positive gastric cancer to potential chemotherapy-free strategies. Therefore, this article reviewed these significant clinical trials and focus on the front-line treatment strategies for HER2-positive gastric cancer.
人表皮生长因子受体 2（HER2）是胃癌的重要治疗靶点。在过去十年中，曲妥珠单抗为基础的化疗策略一直是 HER2 阳性晚期胃癌的一线标准治疗方案。基于曲妥珠单抗治疗胃癌试验，曲妥珠单抗联合顺铂和氟嘧啶类药物的全身化疗作为晚期 HER2 阳性胃癌的一线治疗方案已确立。此后，研究探索了优化一线治疗策略，包括曲妥珠单抗的剂量、化疗方案和维持治疗。进行了大量的临床试验来探索最佳的一线治疗方案，如拉帕替尼和帕妥珠单抗。安全有效的一线治疗方案仍有待探索。最近，两项关于免疫检查点抑制剂联合用于 HER2 阳性晚期胃癌一线治疗的 II 期研究显示出有希望的结果。免疫疗法的进展逐渐推动了晚期 HER2 阳性胃癌的一线治疗向潜在无化疗策略的发展。因此，本文综述了这些重要的临床试验，并重点介绍了 HER2 阳性胃癌的一线治疗策略。
