Expert Perspectives of a 67-Year-Old Man with Metastatic HER2+ Gastric Cancer - Episode 3

Frontline Treatment in Metastatic HER2+ Gastric Cancer

John Marshall, MD

Dr John Marshall discusses frontline systemic treatment options for metastatic HER2+ gastroesophageal junction cancer and gastric cancer in general.

John Marshall, MD: Front-line treatment for patients with metastatic adenocarcinoma of the GE [gastroenterostomy] junction is… doublet chemotherapy is the most commonly offered recommendation. We know in neoadjuvant treatment that we will often use triplet therapy. The FLOT [5FU, folinic acid, oxaliplatin, docetaxel] regimen is commonly used in the neoadjuvant setting. When we look at triplet therapy with 3 chemotherapy agents in the metastatic setting, there hasn't been any demonstration of clear benefits by adding that third medicine, with a few rare circumstances, specifically doublet chemotherapy typically with a fluoropyrimidine and a platinum. I think it's a legitimate choice to use a platinum and a taxane in frontline therapy.

I do think you have choices there. Increasingly we have biologics, which are combined with that doublet therapy obviously in HER22-positive patients. We have trastuzumab in PD-L1 [programmed death-ligand 1]-positive patients. We have different I-O [immuno-oncology] therapies which are being combined with chemotherapy. If you have alternative markers, there may be other front-line options that come into play. They aren't apart from predictive markers, which drugs to use, there aren't many strong prognostic markers. There are genetic inherited cancer genetic markers such as CDH1 that are important to test in most patients. We are referring most of our patients for genetic counseling to do germline testing as we are increasingly seeing germline abnormalities in these patients.

This transcript has been edited for clarity.