Oncology Brothers: Practice-Changing Cancer Discussions

Toxicity Management of HER2+ Treatment Options in Upper GI Cancers – Drs. Geoffrey Ku & Shruti Patel

Dec 18, 2025

In this engaging discussion, Dr. Geoffrey Ku, a renowned medical oncologist at Memorial Sloan Kettering, and Dr. Shruti Patel from Stanford University share their expertise on managing treatment toxicities in HER2-positive upper GI cancers. They explore the complexities of frontline regimens, including trastuzumab and pembrolizumab, highlighting how to tackle common side effects like nausea and diarrhea. The duo also delves into cardiotoxicity and immune-related adverse events, offering practical recommendations for oncologists to enhance patient care.

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ADVICE

Proactively Manage Baseline Chemo Symptoms

Anticipate chemo symptoms like fatigue, nausea, diarrhea, neuropathy and hand-foot when using FOLFOX/XELOX with trastuzumab.
Address baseline dysphagia and nausea proactively because patients often present with these symptoms.

ADVICE

Monitor Immunity And Cardiac Function

Monitor for immune-related adverse events with pembrolizumab, focusing on thyroid dysfunction and adrenal insufficiency.
Continue routine baseline and 3–6 month echos for trastuzumab and involve cardio-oncology if cardiomyopathy appears.

INSIGHT

Synergistic Diarrhea With Zanidatamab + Fluoropyrimidines

Zanidatamab shows little diarrhea as monotherapy but had synergistic severe diarrhea when combined with fluoropyrimidines in phase 2.
Mandatory loperamide and removing 5‑FU bolus reduced grade 3–4 diarrhea markedly.

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Welcome back to the Oncology Brothers podcast! In this episode, we continue the CME series on HER2-positive GEJ and gastric cancer, shifting focus to the essential topic of treatment toxicity management. We're joined by two leading experts: Dr. Geoffrey Ku from Memorial Sloan Kettering and Dr. Shruti Patel from Stanford University.

Building on their previous discussion of upper GI treatment algorithm with Dr. Rutika Mehta, this episode delves into the practical realities of managing patients on complex regimens. Drs. Ku & Patel break down the side effect profiles across the treatment continuum—from frontline trastuzumab-based combinations to emerging therapies like zanidatamab—and provide actionable strategies for community oncologists.

Episode Highlights:
• Practical management of frontline side effects with FOLFOX/XELOX chemotherapy plus trastuzumab and pembrolizumab
• Reality check on trastuzumab cardiotoxicity: incidence rates and monitoring protocols in gastric vs. breast cancer
• Immune-related adverse events with checkpoint inhibitors: what's common vs. rare in GI cancers
• Critical insights on zanidatamab's synergistic diarrhea toxicity and mandatory prophylaxis strategies
• TDXd (Enhertu) in second-line: moving beyond ILD fears to address frequent cytopenias and marrow management
• Expert consensus on infusion reaction management for novel biologics
• The importance of managing baseline symptoms in patients with dysphagia and nausea

This episode bridges the gap between trial data and clinical practice, offering real-world wisdom on keeping patients on effective therapies through proactive toxicity management.

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Accreditation/Credit Designation
Physicians’ Education Resource®, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Physicians’ Education Resource®, LLC designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Acknowledgment of Commercial Support
This activity is supported by an educational grant from Jazz Pharmaceuticals, Inc.

Link to gain CME credits from this activity:
https://www.gotoper.com/courses/navigating-the-adverse-event-landscape-in-her2-gea-therapy