Herceptin for gastric cancer – pro

Many insurers now cover gastric cancer as an appropriate indication under policy for Herceptin therapy, provided that it is HER 3+  by IHC of by FISH, that a cardiac workup was carried out and that it is used in one line of therapy. 22% of patients with advanced gastric cancer overexpress human epidermal growth-factor receptor 2 (HER2), and these patients had significantly improved overall survival when trastuzumab (Herceptin) is added to chemotherapy, compared with chemotherapy alone. In a study presented in 2009 ASCO, the improvement in overall survival was 2.7 months, from 11.1 months in the chemotherapy group to 13.8 months in the trastuzumab group (hazard ratio, 0.74, P = .0046).  SImilar results were shown by ToGA, a large international Phase III trial investigating the benefit of Herceptin as the first therapy for patients with advanced and inoperable stomach cancer (first line).
This would include gastroesophageal junction cancer, which  preliminary results for ToGa show is highly HER+. There are currently no open studies on clinicaltrials.gov of Herceptin for esophageal cancer.

Van Cutsem E, Kang Y, Chung H et al. Efficacy results from the ToGA trial: a Phase III study of trastuzumab added to standard chemotherapy (CT) in first-line human epidermal growth factor receptor 2 (HER2)-positive advanced gastric cancer (GC). Presented at the 2009 annual meeting of the American Society of Clinical Oncology, May 29-June 2, 2009, Orlando, FL. Abstract LBA4509.

Y. Kang, Y. Bang, F. Lordick, S. Park, A. Sawaki, H. Chung, L. Shen, J. M. Xu, J. Leon-Chong, E. Van Cutsem Incidence of gastric and gastro-esophageal cancer in the ToGA trial: Correlation with HER2 positivity 2008 Gastrointestinal Cancers Symposium , Ab. 11

Judith Meza-Junco, Heather-Jane Au, and Michael B Sawyer, Critical appraisal of trastuzumab in treatment of advanced stomach cancer Cancer Manag Res. 2011; 3: 57–64.

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