Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. May 24, 2024; 15(5): 635-643
Published online May 24, 2024. doi: 10.5306/wjco.v15.i5.635
Human epidermal growth factor receptor 2 expression level and combined positive score can evaluate efficacy of advanced gastric cancer
Lin Yang, Bi-Yang Cao, Wen-Wei Yang, Kai Ou, Xiao-Ting Ma
Xiao-Ting Ma, Kai Ou, Wen-Wei Yang, Bi-Yang Cao, Lin Yang, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Author contributions: Ma XT designed the article form and wrote the manuscript; Ou K, Yang WW and Cao BY consulted and browsed the literature; Yang L revised the manuscript and provided the funding. All authors read and approved the final manuscript.
Supported by Beijing CSCO Clinical Oncology Research Foundation, No. Y-HH202102-0314.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board of National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College.
Informed consent statement: As the study used anonymous and pre-existing data, the requirement for the informed consent from patients was waived.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lin Yang, MD, Director, Doctor, Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. linyangcicams@126.com
Received: January 2, 2024
Revised: February 8, 2024
Accepted: April 2, 2024
Published online: May 24, 2024
Processing time: 139 Days and 15.1 Hours
Abstract
BACKGROUND

Although treatment options for gastric cancer (GC) continue to advance, the overall prognosis for patients with GC remains poor. At present, the predictors of treatment efficacy remain controversial except for high microsatellite instability.

AIM

To develop methods to identify groups of patients with GC who would benefit the most from receiving the combination of a programmed cell death protein 1 (PD-1) inhibitor and chemotherapy.

METHODS

We acquired data from 63 patients with human epidermal growth factor receptor 2 (HER2)-negative GC with a histological diagnosis of GC at the Cancer Hospital, Chinese Academy of Medical Sciences between November 2020 and October 2022. All of the patients screened received a PD-1 inhibitor combined with chemotherapy as the first-line treatment.

RESULTS

As of July 1, 2023, the objective response rate was 61.9%, and the disease control rate was 96.8%. The median progression-free survival (mPFS) for all patients was 6.3 months. The median overall survival was not achieved. Survival analysis showed that patients with a combined positive score (CPS) ≥ 1 exhibited an extended trend in progression-free survival (PFS) when compared to patients with a CPS of 0 after receiving a PD-1 inhibitor combined with oxaliplatin and tegafur as the first-line treatment. PFS exhibited a trend for prolongation as the expression level of HER2 increased. Based on PFS, we divided patients into two groups: A treatment group with excellent efficacy and a treatment group with poor efficacy. The mPFS of the excellent efficacy group was 8 months, with a mPFS of 9.1 months after excluding a cohort of patients who received interrupted therapy due to surgery. The mPFS was 4.5 months in patients in the group with poor efficacy who did not receive surgery. Using good/poor efficacy as the endpoint of our study, univariate analysis revealed that both CPS score (P = 0.004) and HER2 expression level (P = 0.015) were both factors that exerted significant influence on the efficacy of treatment the combination of a PD-1 inhibitor and chemotherapy in patients with advanced GC (AGC). Finally, multivariate analysis confirmed that CPS score was a significant influencing factor.

CONCLUSION

CPS score and HER2 expression both impacted the efficacy of immunotherapy combined with chemotherapy in AGC patients who were non-positive for HER2.

Keywords: First line; Gastric cancer; Human epidermal growth factor receptor 2; Programmed cell death protein 1; Progression-free survival

Core Tip: For when considering non-positive human epidermal growth factor receptor 2 (HER2) advanced gastric cancer (AGC), combined positive score and HER2 expression are represent influencing factors for the treatment efficacy of AGC patients receiving immunotherapy combined with chemotherapy. Survival analysis with When using progression-free survival (PFS) as the end point, survival analysis suggested that the HER2 expression level was levels are suggestive of the efficacy of treatment featuring a programmed cell death protein 1 inhibitor combined with and chemotherapy. With the increase of HER2 expression, PFS also showed a tendency to prolong increase with an increase in HER2 expression.