This protocol covers patients with locally advanced unresectable or metastatic gastric cancer whose tumours are HER2-positive. HER2 status shapes the treatment approach at each stage of management in this setting.
Locally advanced unresectable or metastatic gastric cancer with confirmed HER2 positivity. Palliative first-line systemic therapy with trastuzumab combined with fluoropyrimidine/platinum-based chemotherapy is the established initial approach in this population.
Palliative second-line systemic therapy is indicated following progression. The preferred approach involves a targeted anti-angiogenic agent combined with chemotherapy, with additional alternatives available. The complete prioritised options are in the full protocol.
DOI: 10.5230/jgc.2025.25.e11
Palliative first-line systemic therapy with trastuzumab combined with fluoropyrimidine/platinum-based chemotherapy is recommended in patients with HER2-positive locally advanced unresectable or metastatic gastric cancer.
Palliative second-line systemic therapy with ramucirumab combined with paclitaxel is recommended in patients with locally advanced unresectable or metastatic gastric cancer; however, other agents may also be considered.
Other agents, including irinotecan, docetaxel, paclitaxel can also be considered second-line options if not previously administered in the first-line treatment.
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