60
- Regular cardiac assessment for those treated with trastuzumab:
echocardiogram or MUGA scan. - Monitoring of blood pressure and proteinuria for those treated
with ramucirumab.
3 Methods
Trastuzumab-based regimens in first-line setting (see Note 1):
Trastuzumab 8 mg/kg on Day 1 of cycle I then 6 mg/kg on
Day 1 every 3 weeks + Cisplatin 80 mg/m^2 Day 1 + 5FU 800 mg/
m^2 Days 1–5 every 3 weeks.
Or
Cisplatin 80 mg/m^2 Day 1 + capecitabine 1000 mg/m^2 BD
Days 1–14 every 3 weeks.
Ramucirumab-based regimens in second-line setting (see Note 2).
Ramucirumab 8 mg/kg on Day 1 and 15 every 4 weeks.
With or without
Paclitaxel 80 mg/m^2 on Day 1, 8, and 15 every 4 weeks.4 Notes
- Baseline measure of left ventricular ejection fraction should be
checked and then monitored regularly throughout the course
of trastuzumab. Chemotherapy can be stopped after six cycles if
disease is under control while trastuzumab should be given
until progression or unacceptable toxicity. Trastuzumab beyond
progression can be considered in selected patients with previous
good response and good tolerance although this has not been
supported by phase III randomized controlled trial yet. - Monitoring of blood pressure and proteinuria should be done
throughout the treatment period of ramucirumab with or
without paclitaxel. The whole regimen should be continued
until progression but long-term administration is usually lim-
ited by peripheral neuropathy from paclitaxel. - Advanced gastric and esophagogastric junction adenocarci-
noma have very poor prognosis, and target therapy has long
been expected as a cure for the disease. However, the results of
various clinical studies in target therapy have not met the
expectations so far. There were more than 8000 patients
enrolled in major phase III clinical studies of target therapy in
advanced gastric and esophagogastric junction adenocarci-
noma over the past 10 years. In fact, the absolute gains in over-
all survival and progression-free survival in the experimental
arms were merely 1–2 months and some of the new target
agents even made negative impact (Table 1 ).
Ka-On Lam and Dora L. W. Kwong