Clinical outcomes of radical gastrectomy following trastuzumab-based chemotherapy for stage IV HER2-positive gastric or
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ORIGINAL ARTICLE
Clinical outcomes of radical gastrectomy following trastuzumab‑based chemotherapy for stage IV HER2‑positive gastric or gastroesophageal junction cancer Ryo Takahashi1 · Souya Nunobe1 · Hiroki Osumi2 · Daisuke Takahari2 · Noriko Yamamoto3 · Satoshi Ida1 · Koshi Kumagai1 · Manabu Ohashi1 · Takeshi Sano1 · Naoki Hiki4 Received: 28 January 2020 / Accepted: 17 March 2020 © Springer Nature Singapore Pte Ltd. 2020
Abstract Purpose Patients who receive trastuzumab (T-mab) plus chemotherapy for stage IV HER2-positive gastric or gastroesophageal junction cancer sometimes respond remarkably well and can undergo radical surgery. However, the clinical outcomes of preoperative T-mab combined chemotherapy with radical gastrectomy remain unclear. We conducted this study to investigate the clinical outcomes of this multimodal treatment. Methods From among a total of 199 patients who received T-mab-based chemotherapy for stage IV HER2-positive gastric or gastroesophageal junction cancer between 2011 and 2018, the subjects of this retrospective analysis were 20 patients who subsequently underwent radical gastrectomy. Results Seven patients had gastroesophageal junction cancer and 13 had gastric cancer. Eleven patients had unresectable stage IV cancer and 9 had resectable metastatic disease. Chemotherapy regimens included capecitabine, cisplatin + T-mab (11 patients), and S-1, oxaliplatin + T-mab (nine patients). The median number of chemotherapy cycles before surgery was three (range, 2–62). During preoperative chemotherapy, grade 3/4 adverse events developed in six patients. None suffered grade ≥ 3b postoperative complications. The 3-year relapse-free survival (RFS) and overall survival (OS) rates were 58.9% and 89.5%, respectively. Conclusion Combined preoperative T-mab-based chemotherapy and surgery appears to be safe and effective for stage IV HER2-positive gastric or gastroesophageal junction cancer, with a clinically meaningful impact on RFS and OS. Keywords Esophagogastric junction cancer · Gastric cancer · HER2 · Stage IV · Trastuzumab
Introduction
* Souya Nunobe [email protected] 1
Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3‑8‑31Koto‑ku, AriakeTokyo 135‑8550, Japan
2
Department of Gastroenterological Chemotherapy, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
3
Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
4
Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, Kanagawa, Japan
Gastric cancer is the third-leading cause of cancer-related death and the fifth most common cancer diagnosed worldwide, affecting approximately 1 million new individuals and causing > 700,000 deaths each year [1]. Despite recent improvements in diagnostic techniques and perioperative management, producing satisfactory outcomes for resectable gastric cancer [2, 3], most patients with inoperable advanced or metas
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