HER2 Testing and Clinical Decision Making in Gastroesophageal Adenocarcinoma
Guideline Status: Current
Published Online: November 14, 2016
Last Updated: March 21, 2023
Published online November 14, 2016. DOI: 10.1200/JCO.2016.69.4836
Angela Bartley, Mary Kay Washington, Carol Colasacco, Christina Ventura, Nofisat Ismaila, Al B. Benson III, Alfredo Carrato, Margaret L. Gulley, Dhanpat Jain, Sanjay Kakar, Helen J. Mackay, Catherine Streutker, Laura Tang, Megan Troxell, and Jaffer Ajani
Context
ERBB2 (erb-b2 receptor tyrosine kinase 2 or HER2) is currently the only biomarker established for selection of a specific therapy for patients with advanced gastroesophageal adenocarcinoma (GEA). However, there are no comprehensive guidelines for the assessment of HER2 in patients with GEA.
Objectives
To establish an evidence-based guideline for HER2 testing in patients with GEA, formalize the algorithms for methods to improve the accuracy of HER2 testing while addressing which patients and tumor specimens are appropriate, and to provide guidance on clinical decision making.
Design
The College of American Pathologists (CAP), American Society for Clinical Pathology (ASCP), and the American Society of Clinical Oncology (ASCO) convened an Expert Panel to conduct a systematic review of the literature to develop an evidence-based guideline with recommendations for optimal HER2 testing in patients with GEA.
Results
The Panel is proposing 11 recommendations with strong agreement from the open comment participants.
Recommendations
The Panel recommends that tumor specimen(s) from all patients with advanced GEA, who are candidates for HER2-targeted therapy, should be assessed for HER2 status before the initiation of HER2-targeted therapy. Clinicians should offer combination chemotherapy and an HER2-targeted agent as initial therapy for all patients with HER2-positive advanced GEA. For pathologists, guidance is provided for morphologic selection of neoplastic tissue, testing algorithms, scoring methods, interpretation and reporting of results, and laboratory quality assurance.
Conclusion
This guideline provides specific recommendations for assessment of HER2 in patients with advanced GEA while addressing pertinent technical issues and clinical implications of the results.
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