What would your initial treatment be for an elderly patient with metastatic HER2+ GEJ cancer with PD-L1 <5 who cannot tolerate any platinum agents?

The current standard-of-care is based on the KEYNOTE-811 study, which established the combination of pembrolizumab with trastuzumab and a fluoropyrimidine/platinum doublet for tumors with a PD-L1 CPS of 1 or more.

Very recently, trastuzumab has been replaced in the first-line setting by the results ...

I agree with Dr. @Dr. First Last and would add the following comments. First, it would be important to understand the reason the patient cannot tolerate any platinum as we recently saw data from the phase III GO2 trial suggesting reduced dosing of 5FU/platinum was safe and non-inferior in an older a...