Аденокарцинома шлунка / GEJ
Детермінований перегляд YAML-сутності з джерельної бази. Клінічний авторитет лишається за вказаними source ID та статусом клінічного sign-off.
| ID | DIS-GASTRIC |
|---|---|
| Тип | Хвороба |
| Синоніми | GEJ adenocarcinomaGastric and gastroesophageal junction adenocarcinomaStomach cancer (adeno)Аденокарцинома шлунка / GEJ |
| Статус | переглянуто 2026-04-26 | очікує клінічного підпису |
| Хвороби | Не вказано |
| Джерела | SRC-ESMO-GASTRIC-2024 SRC-NCCN-GASTRIC-2025 |
Інформаційна підтримка. Усі рекомендації має перевірити кваліфікований онколог. Технічні перевірки не є клінічною валідацією чи схваленням лікування.
| icd_o_3_morphology | 8140/3 |
|---|---|
| icd_o_3_topography | ["C16"] |
| icd_10 | C16 |
| who_classification | WHO Digestive System Tumours 5th ed: Gastric adenocarcinoma + GEJ adenocarcinoma |
Нотатки
Скафолд для Phase GI-1: один червоний прапор (невідкладна шлунково-кишкова кровотеча/непрохідність), одне показання (FOLFOX + ніволумаб (nivolumab) як найбільш застосовний варіант першої лінії при метастатичному захворюванні) та один алгоритм. Повне покриття (періопераційний FLOT, трастузумаб дерукстекан (trastuzumab deruxtecan) у HER2+ другій лінії, біомаркер-стратифікована перша лінія за каскадом CPS / HER2 / CLDN18.2 / MSI) очікує ратифікації пропозиції та клінічного авторства. Обов'язкові біомаркери відповідно до NCCN gastric v3.2025 §pretreatment у будь-якій метастатичній ситуації: HER2 IHC з рефлекторним ISH, PD-L1 CPS (антитіло 22C3), MSI/dMMR, CLDN18.2 (за наявності лікування), EBER за підозри на EBV-підтип.
Де використовується
Algorithms
ALGO-AMSTERDAM-II-LYNCH- ALGO-AMSTERDAM-II-LYNCHALGO-ESOPH-2L- ALGO-ESOPH-2LALGO-GASTRIC-2L- ALGO-GASTRIC-2LALGO-GASTRIC-METASTATIC-1L- ALGO-GASTRIC-METASTATIC-1LALGO-GASTRIC-RESECTABLE-PERIOP- ALGO-GASTRIC-RESECTABLE-PERIOPALGO-PEUTZ-JEGHERS-CARRIER-SURVEILLANCE- ALGO-PEUTZ-JEGHERS-CARRIER-SURVEILLANCEALGO-PREMM5-LYNCH- ALGO-PREMM5-LYNCH
Procedures
SUR-D2-LYMPHADENECTOMY- Gastrectomy with D2 lymphadenectomy
Questionnaires
QUEST-GASTRIC-1L-STUB- Gastric and gastroesophageal junction adenocarcinoma — first line
Sources
SRC-CHECKMATE-577-KELLY-2021- Adjuvant Nivolumab in Resected Esophageal or Gastroesophageal Junction CancerSRC-CHECKMATE-649-JANJIGIAN-2022- First-line nivolumab plus chemotherapy versus chemotherapy alone for advanced gastric, ga...SRC-DESTINY-GASTRIC01-SHITARA-2020- Trastuzumab Deruxtecan in Previously Treated HER2-Positive Gastric CancerSRC-DESTINY-GASTRIC04-SHITARA-2025- Trastuzumab Deruxtecan or Ramucirumab plus Paclitaxel in Gastric CancerSRC-ESMO-GASTRIC-2024- ESMO Gastric CancerSRC-FLOT4-AL-BATRAN-2019- Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel...SRC-FORTITUDE-101- Bemarituzumab (BEMA) plus chemotherapy for advanced or metastatic FGFR2b-overexpressing g...SRC-GLOW- Zolbetuximab plus CAPOX in CLDN18.2-positive gastric or gastroesophageal junction adenoca...SRC-KEYNOTE-061-SHITARA-2018- Pembrolizumab versus paclitaxel for previously treated, advanced gastric or gastro-oesoph...SRC-KEYNOTE-859-RHA-2023- Pembrolizumab plus chemotherapy versus placebo plus chemotherapy for HER2-negative advanc...SRC-KIM-PEMBRO-EBV-NATMED-2018- Comprehensive molecular characterization of clinical responses to PD-1 inhibition in meta...SRC-NCCN-GASTRIC-2025- NCCN Gastric CancerSRC-OMEC-1-KROESE-2023- Definition, diagnosis and treatment of oligometastatic oesophagogastric cancer: A Delphi...SRC-RAINBOW-WILKE-2014- Ramucirumab plus paclitaxel versus placebo plus paclitaxel in patients with previously tr...SRC-RENAISSANCE-AIO-FLOT5- The RENAISSANCE (AIO-FLOT5) trial: effect of chemotherapy alone vs. chemotherapy followed...SRC-SPOTLIGHT-SHITARA-2023- Zolbetuximab plus mFOLFOX6 in patients with CLDN18.2-positive, HER2-negative, untreated,...SRC-TCGA-GASTRIC-BASS-2014- Comprehensive molecular characterization of gastric adenocarcinomaSRC-TOGA-BANG-2010- Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of H...
Клінічна застосовність
BMA-CLDN18-2-GASTRIC- Zolbetuximab (anti-CLDN18.2 chimeric IgG1 mAb) + chemotherapy is FDA-approved (Oct 2024)...BMA-EBV-POSITIVE-GASTRIC- EBV-positive gastric adenocarcinoma is a TCGA-defined molecular subtype (~9% of gastric a...BMA-FGFR2-AMP-GASTRIC- FGFR2 amplification in gastric/GEJ adenocarcinoma (~5-7% high-level): bemarituzumab (anti...BMA-FGFR2B-MEMBRANE-GASTRIC- FGFR2b protein overexpression (IHC 2+/3+ membranous in ≥10% of tumor cells) identifies a...BMA-HER2-AMP-GASTRIC- HER2-positive gastric/GEJ adenocarcinoma (~15-20%): trastuzumab + chemotherapy is standar...BMA-KRAS-G12C-GASTRIC- KRAS G12C in gastric/GEJ adenocarcinoma is rare. Sotorasib basket data limited; trial-onl...BMA-KRAS-G12D-GASTRIC- KRAS G12D in gastric — no approved targeted therapy.BMA-MET-AMP-GASTRIC- MET amplification in gastric / GEJ adenocarcinoma (~5%): preclinical rationale strong but...BMA-MLH1-GERMLINE-GASTRIC- MLH1 germline loss-of-function in gastric produces dMMR/MSI-H phenotype. Pan- tumor MSI-H...BMA-MLH1-SOMATIC-GASTRIC- MLH1 somatic loss-of-function in gastric produces dMMR/MSI-H phenotype. Pan- tumor MSI-H...BMA-MSH2-GERMLINE-GASTRIC- MSH2 germline loss-of-function in gastric produces dMMR/MSI-H phenotype. Pan- tumor MSI-H...BMA-MSH2-SOMATIC-GASTRIC- MSH2 somatic loss-of-function in gastric produces dMMR/MSI-H phenotype. Pan- tumor MSI-H...BMA-MSH6-GERMLINE-GASTRIC- MSH6 germline loss-of-function in gastric produces dMMR/MSI-H phenotype. Pan- tumor MSI-H...BMA-MSH6-SOMATIC-GASTRIC- MSH6 somatic loss-of-function in gastric produces dMMR/MSI-H phenotype. Pan- tumor MSI-H...BMA-MSI-STATUS-GASTRIC- MSI-H gastric/GEJ adenocarcinoma (~5-10% of cases) is associated with improved response t...BMA-PDL1-CPS-GASTRIC- PD-L1 CPS is a continuous IHC score used as an eligibility threshold for ICI-containing r...BMA-PIK3CA-HOTSPOT-GASTRIC- PIK3CA mutations in ~10% of gastric/GEJ adenocarcinoma. No PI3Ki/AKTi approval; trastuzum...BMA-PMS2-GERMLINE-GASTRIC- PMS2 germline loss-of-function in gastric produces dMMR/MSI-H phenotype. Pan- tumor MSI-H...BMA-PMS2-SOMATIC-GASTRIC- PMS2 somatic loss-of-function in gastric produces dMMR/MSI-H phenotype. Pan- tumor MSI-H...BMA-TP53-MUT-GASTRIC- TP53 mutation in GASTRIC — common, adverse prognostic; not directly targeted. Per usual a...
Показання
IND-CHRONIC-ATROPHIC-GASTRITIS-PREVENTION-OBSERVATION- IND-CHRONIC-ATROPHIC-GASTRITIS-PREVENTION-OBSERVATIONIND-CHRONIC-ATROPHIC-GASTRITIS-PREVENTION-SURVEILLANCE- IND-CHRONIC-ATROPHIC-GASTRITIS-PREVENTION-SURVEILLANCEIND-GASTRIC-METASTATIC-1L-CLDN18-2-ZOLBETUXIMAB- IND-GASTRIC-METASTATIC-1L-CLDN18-2-ZOLBETUXIMABIND-GASTRIC-METASTATIC-1L-FGFR2B-BEMARITUZUMAB- IND-GASTRIC-METASTATIC-1L-FGFR2B-BEMARITUZUMABIND-GASTRIC-METASTATIC-1L-HER2-TOGA- IND-GASTRIC-METASTATIC-1L-HER2-TOGAIND-GASTRIC-METASTATIC-1L-PDL1-CHEMO-ICI- IND-GASTRIC-METASTATIC-1L-PDL1-CHEMO-ICIIND-GASTRIC-METASTATIC-2L-HER2-TDXD- IND-GASTRIC-METASTATIC-2L-HER2-TDXDIND-GASTRIC-METASTATIC-2L-RAMUCIRUMAB-PACLITAXEL- IND-GASTRIC-METASTATIC-2L-RAMUCIRUMAB-PACLITAXELIND-GASTRIC-METASTATIC-3L-TAS102- IND-GASTRIC-METASTATIC-3L-TAS102IND-GASTRIC-OLIGOMET-SYSTEMIC-PLUS-LOCAL- IND-GASTRIC-OLIGOMET-SYSTEMIC-PLUS-LOCALIND-GASTRIC-PERIOP-FLOT4- IND-GASTRIC-PERIOP-FLOT4IND-H-PYLORI-PREVENTION-ERADICATION- IND-H-PYLORI-PREVENTION-ERADICATIONIND-H-PYLORI-PREVENTION-OBSERVATION- IND-H-PYLORI-PREVENTION-OBSERVATIONIND-HDGC-CDH1-CARRIER-PREVENTION-OBSERVATION- IND-HDGC-CDH1-CARRIER-PREVENTION-OBSERVATIONIND-HDGC-CDH1-CARRIER-PREVENTION-SURVEILLANCE- IND-HDGC-CDH1-CARRIER-PREVENTION-SURVEILLANCEIND-IATROGENIC-LONG-TERM-PPI-GASTRIC-NET-PREVENTION-OBSERVATION- IND-IATROGENIC-LONG-TERM-PPI-GASTRIC-NET-PREVENTION-OBSERVATIONIND-IATROGENIC-LONG-TERM-PPI-GASTRIC-NET-PREVENTION-SURVEILLANCE- IND-IATROGENIC-LONG-TERM-PPI-GASTRIC-NET-PREVENTION-SURVEILLANCEIND-LIFESTYLE-SALTY-PICKLED-DIET-GASTRIC-PREVENTION-OBSERVATION- IND-LIFESTYLE-SALTY-PICKLED-DIET-GASTRIC-PREVENTION-OBSERVATIONIND-LIFESTYLE-SALTY-PICKLED-DIET-GASTRIC-PREVENTION-SURVEILLANCE- IND-LIFESTYLE-SALTY-PICKLED-DIET-GASTRIC-PREVENTION-SURVEILLANCE
Тривожна ознака
RF-ACTIVE-AUTOIMMUNE-DISEASE-ICI-RISK- Patient with active or incompletely controlled pre-existing autoimmune or inflammatory di...RF-BREAST-CDH1-LOBULAR-CANDIDATE- Germline CDH1 (E-cadherin) pathogenic variant in invasive lobular breast carcinoma — INFO...RF-CASCADE-FAP-FDR-POSITIVE- A first-degree relative of the patient (parent, sibling, or child) has a documented posit...RF-CASCADE-LYNCH-FDR-POSITIVE- A first-degree relative of the patient (parent, sibling, or child) has a documented posit...RF-CHRONIC-ATROPHIC-GASTRITIS-PREVENTION- Chronic atrophic gastritis (CAG) — histologically confirmed loss of oxyntic and/or antral...RF-CHRONIC-H-PYLORI-MALIGNANCY-PREVENTION- Chronic Helicobacter pylori infection (positive urea breath test, stool antigen, gastric...RF-CRONKHITE-CANADA-CONFIRMED- Cronkhite-Canada syndrome — acquired non-Mendelian polyposis- ectodermal syndrome. Rare (...RF-FAP-CONFIRMED-CARRIER- Patient has a confirmed germline APC pathogenic variant. Mandates structured colorectal +...RF-FAP-FAMILY-HISTORY-SUSPICION- Family pedigree suggestive of Familial Adenomatous Polyposis (FAP) or the attenuated FAP...RF-GASTRIC-CLDN18-2-ACTIONABLE- CLDN18.2 expression positive (≥75% of tumor cells with 2+/3+ membranous staining on VENTA...RF-GASTRIC-EMERGENCY-BLEED-OBSTRUCTION- Surgical/endoscopic emergency in gastric/GEJ adenocarcinoma: massive upper-GI bleed requi...RF-GASTRIC-FRAILTY-AGE- Frailty profile precluding standard FOLFOX+nivo / FLOT in gastric cancer: ECOG ≥3, OR (ag...RF-GASTRIC-HIGH-RISK-BIOLOGY- Treatment-defining biomarkers in metastatic gastric/GEJ adenocarcinoma: HER2+ (IHC 3+ OR...RF-GASTRIC-INFECTION-SCREENING- Infection-screening gate before metastatic gastric/GEJ adenocarcinoma systemic therapy: H...RF-GASTRIC-PDL1-CPS-1-PLUS- Advanced/metastatic gastric or GE-junction adenocarcinoma with PD-L1 combined positive sc...RF-GASTRIC-TRANSFORMATION-PROGRESSION- Aggressive progression in gastric/GEJ adenocarcinoma: linitis plastica (signet-ring diffu...RF-HDGC-CDH1-CONFIRMED-CARRIER- Confirmed germline pathogenic / likely-pathogenic variant in CDH1 (E-cadherin) — Heredita...RF-IATROGENIC-LONG-TERM-PPI-GASTRIC-NET-PREVENTION- Chronic proton-pump inhibitor (PPI) exposure ≥10 years (omeprazole, esomeprazole, pantopr...RF-JPS-CONFIRMED-CARRIER- Confirmed germline pathogenic / likely-pathogenic variant in SMAD4 or BMPR1A — Juvenile P...RF-LIFESTYLE-SALTY-PICKLED-DIET-GASTRIC-PREVENTION- Habitual high intake of salt-preserved foods, pickled vegetables, and high-salt dishes (>...RF-LYNCH-CONFIRMED-CARRIER- Confirmed germline pathogenic / likely-pathogenic variant in a Lynch syndrome (MMR / EPCA...RF-LYNCH-FAMILY-HISTORY-SUSPICION- Family pedigree meeting criteria suggestive of hereditary nonpolyposis colorectal cancer...RF-OLIGOMET-DEFINITION- Oligometastatic esophagogastric adenocarcinoma per OMEC-1 (OligoMetastatic Esophagogastri...RF-PEUTZ-JEGHERS-CONFIRMED-CARRIER- Confirmed germline pathogenic / likely-pathogenic variant in the STK11 (LKB1) gene — Peut...RF-PEUTZ-JEGHERS-FAMILY-HISTORY-SUSPICION- Family pedigree suggestive of Peutz-Jeghers syndrome (PJS): any of (a) a family member wi...
Хвороба
DIS-ESOPHAGEAL- Esophageal carcinoma (squamous + adeno)