Would you consider use of T-DXd for metastatic gastric/GEJ cancers with "HER2 low" given emerging data in the breast cancer setting?

Great -- and timely -- question. DESTINY-Gastric01, the East Asian study that led to T-DXd being approved in the U.S. and the drug being approved as 3L therapy in Japan, included 2 cohorts for Her2 low tumors. Cohort 1 consisted of IHC 2+/FISH negative tumors and Cohort 2 enrolled IHC 1+/FISH negati...

At this point in time, we do not have strong evidence for benefit of T-Dxd in Her2 low patients with gastric/GEJ cancers and cannot necessarily extrapolate data from breast cancer into this setting. A recent analysis of a cohort of Asian patients with Her2 low gastric/GEJ cancers enrolled in the Des...

I would prefer to find a clinical trial utilizing HER2-directed therapy for this particular population, but I would definitely consider T-Dxd if there are no trials available. While preliminary in nature, the publication from Yamaguchi and colleagues, PMID 36379002 supports the benefit of T-Dxd for ...