Daniel Catenacci, MD

Evaluation of a Patient With Gastric Cancer

Considerations for Therapy in Gastric Cancer

Second-Line Treatment Options in Gastric Cancer

Beyond Second-Line Therapy in Gastric Cancer

HER2-Positive Gastric Cancer

Understanding the DESTINY-Gastric01 Trial

Case: A 71-Year-Old Man With HER2+ Gastric Cancer

A 71-year-old man complained of a 3-month history of abdominal pain and bloating, a sensation of fullness

PMH: HTN, medically controlled; colonoscopy at age 53 was unremarkable; no family history of cancer

PE: patient appeared tired, abdominal distention; otherwise unremarkable



Labs: Hb 9.7 g/dL, plt 111 x 109/L; other lab values WNL

Upper endoscopy with biopsy: showed an ulcerative lesion 5.8 cm mass in the cardia of the stomach; biopsy confirmed gastric adenocarcinoma

CT of chest/abdomen/pelvis confirmed a 5.8 cm lesion with indistinct margins in the cardia of the stomach; 2 suspicious hepatic lesions

EUS: gastric cancer lesion confirmed invasion of the muscularis propria

Stage IV gastric adenocarcinoma; ECOG 2



He was started on XELOX/CAPOX + trastuzumab

Dose reduced due to grade 2 diarrhea; unable to control after 4 cycles; discontinued treatment

After 24-months of treatment without progression of disease pembrolizumab was discontinued

The patient was started on trastuzumab deruxtecan; repeat HER2 expression testing was not indicated

Videos

Daniel Catenacci, MD, reviews the case of a 71-year-old man with gastric cancer.

A 71-Year-Old Man with Gastric Cancer

Daniel Catenacci, MD, associate professor, University of Chicago, discusses how he makes decisions with immunotherapeutic agents for the treatment of patients with gastroesophageal junction (GEJ) cancer. He says he bases his sequencing decisions on a number of factors.

These factors include what line of therapy the patient is at, patient characteristics, burden of disease, symptoms, and the patient&rsquo;s performance status, says Catenacci. Many studies today are selecting patients based on given biomarkers that require central confirmation. However, it takes several weeks to get that answer, imposing a selection bias by making patients wait that period of time before beginning treatment.

Because of this, patients on studies are not necessarily representative of real-world patients where many patients need therapy almost immediately in any line, Catenacci adds. These patients are often better served by receiving chemotherapy first.

These factors can help in determining the&nbsp;sequence of immunotherapy for patients with GEJ cancer. Catenacci says treatment can be optimized for&nbsp;

each patient by understanding the patient characteristics and the biology of the tumor. For example, if the tumor is microsatellite instability

Daniel Catenacci, MD, discusses how he makes decisions with immunotherapeutic agents for the treatment of patients with gastroesophageal junction cancer. He says he bases his sequencing decisions on a number of factors.

Daniel Catenacci, MD | Authors

Articles

A 71-Year-Old Man with Gastric Cancer

Determining the Optimal Timing for Immunotherapy in Patients With GEJ Cancers