Adenocarcinoma esofágico HER2 positivo/GEJ marcado por criterios gástricos: trastuzumab + que...
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| ID | BMA-HER2-AMP-ESOPHAGEAL |
|---|---|
| Tipo | Relevancia terapéutica |
| Situación | reviewed 2026-04-27 | pending_clinical_signoff | actionability review required |
| Enfermedades | DIS-ESOPHAGEAL |
| Fuentes | SRC-ESMO-ESOPHAGEAL-2024 SRC-NCCN-ESOPHAGEAL-2025 |
Hechos relativos a la posibilidad de adoptar medidas
| Biomarcador | BIO-HER2-SOLID |
|---|---|
| Variante | amplificación/expresión excesiva — IHC 3+ o (IHC 2+ + ISH amplificado) utilizando los criterios de Hofmann gástrico 2008; ~10-30% de adenocarcinoma esofágico/GEJ |
| Enfermedad | DIS-ESOPHAGEAL |
| El nivel de ESCAT | IA |
| Combinaciones recomendadas | trastuzumab + fluoropyrimidine + platinum (1L per SRC-NCCN-ESOPHAGEAL-2025, SRC-ESMO-ESOPHAGEAL-2024), pembrolizumab + trastuzumab + fluoropyrimidine + platinum (1L HER2+ PD-L1 CPS≥1 GEJ adenocarcinoma per SRC-NCCN-ESOPHAGEAL-2025), trastuzumab deruxtecan (2L+ per SRC-NCCN-ESOPHAGEAL-2025) |
| Monoterapia contraindicada | trastuzumab en monoterapia, tratamiento anti-HER2 en carcinoma esofágico de células escamosas |
| Resumen de las pruebas | HER2-positive esophageal/GEJ adenocarcinoma scored by gastric criteria: trastuzumab + chemotherapy is preferred 1L (cross-referenced from ToGA / KEYNOTE-811) per SRC-NCCN-ESOPHAGEAL-2025, SRC-ESMO-ESOPHAGEAL-2024. Pembrolizumab + trastuzumab + fluoropyrimidine/platinum is FDA-approved for HER2+ PD-L1 CPS≥1 metastatic GEJ adenocarcinoma (KEYNOTE-811). Trastuzumab deruxtecan is FDA-approved 2L+ for HER2-positive advanced gastric/GEJ adenocarcinoma (DESTINY-Gastric01 includes Siewert types). Squamous-cell esophageal carcinoma is HER2-negative as a rule and is not in scope for HER2-directed therapy. |
Notas
ESCAT IA / OncoKB Level 1. HER2 testing for adenocarcinoma histology only (not squamous). Heterogeneity high — ≥4 biopsies recommended. Bibliographic record SRC-DESTINY-GASTRIC01-SHITARA-2020 is available; SRC-TOGA-BANG-2010 and SRC-KEYNOTE-811 remain source gaps. Claim-level linkage requires clinical sign-off.
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