Oncology Today with Dr Neil Love Advanced Gastroesophageal Cancers — Expert Perspectives on Actual Patient Cases: Part 2 of 2
Dec 22, 2025
Dr Yelena Janjigian, a medical oncologist and clinical investigator at Memorial Sloan Kettering known for her work in gastroesophageal cancers, discusses HER2 advances, bispecifics, and newer antibody drug conjugates. She covers toxicity management, sequencing options like T-DXd, biomarker prioritization (MSI, PD-L1, CLDN18.2), and real-world case-based treatment choices in advanced disease.
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Anticipate Indirect Comparisons With New HER2 Bispecific Trials
- Do critically evaluate new HER2 bispecific trial designs and expect indirect comparisons versus current standards when cross-trial IO use differs.
- Yelena Janjigian warns Horizon GEA01 randomizes zanidatamab+chemo ± tislelizumab versus trastuzumab+chemo, complicating interpretation against pembrolizumab-containing regimens.
Start Diarrhea Prophylaxis With HER2 Bispecifics
- Try prophylactic antidiarrheals and early loperamide when using HER2 bispecifics with fluoropyrimidines to manage high diarrhea risk.
- Janjigian noted phase 2 zanidatamab plus capecitabine had ~40% grade 3–4 diarrhea, prompting prophylaxis in phase 3.
Re-biopsy At Progression To Confirm HER2 For T-DXd
- Re-biopsy progressing lesions to reassess HER2 status before prescribing T-DXd.
- Janjigian emphasizes intratumoral heterogeneity and FDA recommends re-biopsy; ctDNA alone may miss HER2 loss.