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Cautious optimism appropriate for a cancer with a historically dismal outlook.

March 23, 2009

Analysis of:UPDATE 1-Roche's Herceptin prolongs stomach cancer survival | www.reuters.com

Many adenocarcinomas and sqamous cell cancers express HER2 . However, HER2 based therapy is only approved therapy in early and late stage breast cancer. 25% of gastric cancers express HER2. The Toga trial was conducted practically everywhere except the US; indeed there are geographic differences in gastric cancer in regards to risks, location, age of diagnosis, stage at presention, etc.. which are notable. However, the trial appears well powered between arms. The ToGA trial used a somewhat outdated regimen as control (5FU +CDDDP) however for study purposes that was appropriate. Other regimens will be compared to the H+chemo arm across studies (TPF, regimens investigated in REAL, etc..). I would assume minimal toxicity was added with H (aside from cardiac). Although we should all be optimistic (gastric cancer has a 5 yr median survival of 10-15%; incidence of proximal gastric and GE cancer is increasing more than any other cancer) results will need to be scrutinized when available.

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