HER2 Testing in Gastric and Gastroesophageal Junction Cancers: A New Therapeutic Target and Diagnostic Challenge

Adenocarcinomas of the stomach and gastroesophageal junction represent a major cause of cancer morbidity and mortality world wide. Complete surgical resection is the mainstay of treatment for nonmetastatic disease; however, many patients are not diagnosed until their disease is either locally advanced or metastatic and therefore unresectable. Clearly, there is an unmet clinical need for new therapeutic strategies, treatment options, and novel therapeutic targets. In a recent trial (Trastuzumab for GAstric cancer), patients assigned to the trastuzumab treatment protocol showed an improved overall survival over those not receiving treatment. Trastuzumab has recently been approved for treatment of advanced gastric and gastroesophageal junction cancers. Pathologists and diagnostic laboratories must be prepared for this new category of specimens requiring human epidermal growth factor receptor 2 testing, and have an awareness of the interpretive differences between breast and gastric cancers.