Third-line treatment of advanced HER2-negative gastric cancer with MSI-H / dMMR status
This protocol addresses advanced or metastatic gastric cancer that is HER2-negative and characterised by microsatellite instability-high (MSI-H) or mismatch repair-deficient (dMMR) status — a biomarker-defined sub-population with specific evidence-based options at the third line.
The patient has advanced or metastatic gastric cancer, confirmed HER2-negative, with microsatellite instability-high (MSI-H) / mismatch repair-deficient (dMMR) tumour status, and has progressed following two prior lines of systemic therapy.
At the third line, a specific antineoplastic combination is the recommended approach for this population. Alternative cytotoxic options are also recognised in this setting. The complete evidence-graded regimen — including all options, sequencing, and recommendations — is available in the full protocol.
DOI: 10.1016/j.annonc.2022.07.004
- Pembrolizumab is recommended for second-line treatment of patients with MSI-H/dMMR gastric cancer [II, A; ESMO-MCBS v1.1 score: 3; ESCAT score: I-B].
- For patients previously treated with two lines of therapy, trifluridine–tipiracil is recommended [I, A; ESMO-MCBS v1.1 score: 3]. Alternative treatments include a taxane or irinotecan [II, B].