Increased assessment of HER2 in metastatic gastroesophageal cancer patients: a nationwide population-based cohort study

Willemieke P. M. Dijksterhuis, Rob H. A. Verhoeven, Sybren L. Meijer, Marije Slingerland, Nadia Haj Mohammad, Judith de Vos-Geelen, Laurens Beerepoot, Theo van Voorthuizen, Geert-Jan Creemers, Martijn G. H. van Oijen, Hanneke W. M. van Laarhoven*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Background Addition of trastuzumab to first-line palliative chemotherapy in gastroesophageal cancer patients with HER2 overexpression has shown to improve survival. Real-world data on HER2 assessment and administration of trastuzumab are lacking. The aim of this study was to assess HER2 testing, trastuzumab administration, and overall survival (OS) in a nationwide cohort of metastatic gastroesophageal cancer patients. Methods Data of patients with synchronous metastatic gastroesophageal adenocarcinoma diagnosed in 2010-2016 that received palliative systemic treatment (n = 2846) were collected from the Netherlands Cancer Registry and Dutch Pathology Registry. The ToGA trial criteria were used to determine HER2 overexpression. Proportions of HER2 tested patients were analyzed between hospital volume categories using Chi-square tests, and over time using trend analysis. OS was tested using the Kaplan Meier method with log rank test. Results HER2 assessment increased annually, from 18% in 2010 to 88% in 2016 (P <0.01). Median OS increased from 6.9 (2010-2013) to 7.9 months (2014-2016;P <0.05). Between the hospitals, the proportion of tested patients varied between 29-100%, and was higher in high-volume hospitals (P <0.01). Overall, 77% of the HER2 positive patients received trastuzumab. Median OS was higher in patients with positive (8.8 months) and negative (7.4 months) HER2 status, compared to non-tested patients (5.6 months;P <0.05). Conclusion Increased determination of HER2 and administration of trastuzumab have changed daily practice management of metastatic gastroesophageal cancer patients receiving palliative systemic therapy, and possibly contributed to their improved survival. Further increase in awareness of HER2 testing and trastuzumab administration may improve quality of care and patient outcomes.

Original languageEnglish
Pages (from-to)579-590
Number of pages12
JournalGastric Cancer
Issue number4
Publication statusPublished - Jul 2020


  • Esophageal neoplasms
  • Gastric neoplasms
  • Adenocarcinoma
  • ErbB-2 receptor
  • Drug therapy
  • Trastuzumab


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