ArticleThe oncologist2026
Treatment outcomes of trastuzumab-based chemotherapy in patients with HER2-positive gastric cancer: a nationwide retrospective cohort study.
Article in The oncologist, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundTrastuzumab-based chemotherapy is the standard first-line treatment for patients with human epidermal growth factor receptor 2 (HER2)-positive advanced or metastatic gastric cancer (GC). However, evidence on real-world outcomes according to the chemotherapy backbone remains limited.
methodsA total of 2399 patients with GC treated with trastuzumab-based chemotherapy were analyzed, of whom 486 patients were treated with trastuzumab/5-fluorouracil/cisplatin (HFP) and 1913 patients were treated with trastuzumab/capecitabine/cisplatin (HXP). Time to subsequent treatment (TST) and overall survival (OS) were analyzed according to the type of chemotherapy backbone.
resultsWith a median follow-up of 10.5 months, the median TST was 6.08 months (95% confidence interval [CI], 5.65-6.60) in the HFP group and 8.02 months (95% CI, 7.72-8.57) in the HXP group (P < .0001). The median OS was 9.89 months (95% CI, 8.94-10.87) for the HFP group and 13.27 months (95% CI, 12.75-14.00) for the HXP group (P < .0001). Specifically, HXP followed by trastuzumab and capecitabine maintenance (HXP-HX) demonstrated the best outcomes with median TST of 13.44 months (95% CI, 12.52-15.61) and median OS of 22.18 months (95% CI, 20.83-24.44) compared with HXP followed by trastuzumab maintenance (HXP-H) and HXP alone (both P < .0001), which were also significant in multivariable analysis.
conclusionsTrastuzumab/capecitabine/cisplatin followed by trastuzumab/capecitabine maintenance showed the best survival outcomes for patients with locally advanced unresectable or metastatic HER2-positive GC based on real-world big data analysis of the Trastuzumab for Gastric Cancer regimen, suggesting that HXP-HX is recommended over HXP-H. In the current immunotherapy era for HER2-positive GC, the potential role of capecitabine maintenance as part of combination strategies should be interpreted cautiously and warrants further investigation.
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