Important Questions to Ask the Care Team About HER2 Positive Gastric Cancer Treatment Options

As a gastric cancer patient and their loved ones ask important questions regarding their new diagnosis of HER2-positive gastric cancer, it is very important that they understand their new diagnosis, as well as their many treatment options and their potential side effects. Because there are many differing opinions in the medical community, and a lot of confusion surrounding the diagnosis of HER2-positive gastric cancer and treatment of this rare cancer, it is key that patients take the time to thoroughly question their medical care team in order to fully understand all of their choices.

Stomach cancer is a cancer of the stomach (gastrointestinal) tract. Gastric cancer with an overexpression of the human epidermal growth factor receptor 2. (HER2) has been studied with HER2-targeted therapies such as trastuzumab. Importantly, other factors need to be considered for selecting appropriate treatment such as the tumor stage, prior cancer treatment, patient’s overall medical condition, and other biomarkers in the tumor.

Questions About the Diagnosis and HER2 Testing

Patients should discuss any questions or concerns with their oncologist, what your test results mean in terms of the choices of medicines that he or she recommends for your treatment. The accuracy of the HER2 test results is important for choosing her2-positive gastric cancer treatment.

Consider asking the care to team the following questions:

• Has my cancer been confirmed as HER2-positive and what are the results of the path test?
• Was HER2 status assessed using IHC (immunohistochemistry) and/or ISH (in situ hybridization) and/or other assays?
• What is the stage of my cancer, and does it spread from the stomach to other parts of the body?
• Are additional biomarker tests needed to guide treatment decisions?

It’s also important to determine whether other biomarkers are needed to consider other treatment options. For example, expression of PD-L1 or a tumor’s mismatch repair (MMR) status can influence whether a patient might benefit from immunotherapy.

Questions About Available Treatment Options

Treatment of stomach cancer depends on local spread of the tumor and general health of the patient. For localized cancer, treatment may involve a surgical resection of part of the stomach or stomach with or without adjuvant chemotherapy. Patients with advanced, unresectable cancer or with distant metastases are treated with systemic therapy using regimens that include chemotherapy and / or HER2-targeted therapies, and/or immunotherapies given singly or in combination.

It is also very important for patients to understand the reasons an oncologist has recommended certain treatments over others. This can help them to make informed decisions concerning their cancer treatment.

Important questions include:

• What is the goal of this treatment for me?
• Is surgery possible, or is systemic treatment recommended?
• Which HER2-targeted medicines may be suitable for me?
• Should chemotherapy be combined with targeted therapy or with immunotherapy?
• Are there any clinical trials that I may be eligible for?

Tislelizumab is used to treat advanced HER2 positive gastric or gastroesophageal junction cancer, as part of a combination with chemotherapy for eligible patients. Tislelizumab may be considered as an alternative option following prior treatment based on individual patient circumstances and current clinical guidance.

It is also helpful for patients to understand the reasoning behind a doctor’s treatment choices so that they can compare and contrast treatment options and realize that just because a certain medication is used in many cases, it does not mean that it will be the best choice for every patient.

Understanding the Expected Benefits and Treatment Timeline

It is important for patients to understand the expected benefits of a certain treatment in relation to their individual circumstances as well as the potential impact of the treatment on their daily life and expected outcomes. When discussing the treatment options, including her2 positive gastric cancer treatment, ask:

• What benefits can realistically be expected from the recommended treatment?
• How would we determine if the treatment is working?
• When will scans or other assessments be performed?
• What is the expected duration of treatment to control the cancer?
• What other treatments would be available to you should your cancer start to grow on Tislelizumab, or should it cease to work after a period?

Discussing treatment expectations with your oncologist can help support treatment goals throughout care and monitoring of cancer and its treatment. Also, it is good to establish whether the intention of a particular treatment is to control cancer, prevent recurrence or to treat other symptoms associated with your primary diagnosis.

Questions About Side Effects and Safety

In cancer treatment, as with all medicine, there are potential risks of side effects. The side effects of a treatment can vary greatly from person to person. Patients are encouraged to discuss potential side effects of a recommended treatment with their oncologist and ask which symptoms are considered urgent.

The frequency and severity of typical side effects can vary from patient to patient and should be discussed by the oncology team prior to initiation of any medications. Additionally, some cancer treatments require close monitoring by the oncology care team for potential treatment-related toxicities such as changes in blood counts, liver or kidney function, cardiac function, and infusion reactions.

For example, any treatment must be monitored for effects on the heart, and so it is standard practice for patients to have cardiac assessments before starting and during treatment. Other medicines need to be monitored for different aspects, such as changes to blood counts, onset of symptoms such as nausea, vomiting, diarrhea or constipation, and the risk of an infusion reaction.

Can there be contact with other members of the team outside of the normal clinic? Are there any existing medicines, supplements or medical problems that could have an impact on the safety of the treatment?

Discussing Nutrition and Everyday Care

Nutrition is an important aspect of gastric cancer care and may be addressed early in treatment discussions to prevent unnecessary problems with weight loss and reduced appetite.

Useful questions include:

• Should I follow any specific dietary recommendations during treatment?
• Would an oncology dietitian help manage weight loss or reduce appetite?
• How can nausea, vomiting, diarrhea, or constipation be managed?
• What are the indicators of severe dehydration or poor nutrition that I should report to you?
• Is physical activity appropriate during treatment?

The recommendation for nutritional intake can include suggestions from an oncology dietitian on the best type of meals to eat, and the frequency and size of meals. This can vary from having small frequent meals throughout the day, to having normal sized meals, depending on individual circumstances.

Families can assist the patient in keeping track of meals and of symptoms. They can accompany the patient to appointments that the patient wishes them to attend.

Planning Follow-Up Care and Getting Support

What are the arrangements for treatment, including administration of medication and blood tests and imaging investigations?

Does the hospital have any information about the costs of treatment and coverage by insurance? Are there any services to help patients with transportation? Are there any services for supportive care?

Finally, summaries your decisions and list all the actions that need to be taken before you leave the appointment. It is helpful to organize your pathology reports, lists of your current medication, results of your tests and any contact details for future reference.

Making Informed Decisions with the Oncology Team

All these questions need to be asked by the patient in order for them to make informed decisions about their HER2-positive gastric cancer treatment. This is equally true in terms of them receiving adequate information in relation to their diagnosis and the potential benefits and problems associated with the various treatment options available to them.

We need an individualized approach to the treatment of HER2-positive gastric cancer, using clinical evidence to guide our recommendations and be sensitive to individual circumstances of our patients. Effective communication may help patients and families to make informed decisions about their treatment plans and to prepare them for the medical care that they will receive.

Disclaimer: The information provided in this article is intended for educational purposes only and should not be interpreted as medical advice, a clinical guideline, or a recommendation for any specific treatment.