A 58-year-old man with gastric adenocarcinoma of the antrum is found to have peritoneal deposits at staging laparoscopy. The primary tumor is unresectable. According to the ToGA trial, which treatment combination showed improved survival in HER2-positive gastric/GEJ adenocarcinoma?
- A Capecitabine + cisplatin + trastuzumab ✓
- B FOLFOX + bevacizumab
- C Docetaxel + nivolumab
- D 5-FU + ramucirumab
Correct answer: A. Capecitabine + cisplatin + trastuzumab
Explanation
The ToGA trial (2010) was the pivotal trial establishing HER2-targeted therapy in gastric/gastroesophageal junction adenocarcinoma. It demonstrated that the addition of trastuzumab (anti-HER2 monoclonal antibody) to capecitabine + cisplatin chemotherapy significantly improved median overall survival (13.8 vs 11.1 months) in HER2-positive advanced gastric cancer (IHC3+ or IHC2+/FISH+). This led to HER2 testing becoming mandatory in advanced gastric cancer. Approximately 15-20% of gastric cancers are HER2-positive, especially the intestinal subtype at the GEJ.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.