Oncology Today with Dr Neil Love HER2-Positive Gastrointestinal Cancers — Microlearning Activity 1: Proceedings from a Session Held Adjunct to the 2026 ASCO GI Cancers Symposium
Mar 14, 2026
Prof Eric Van Cutsem, GI oncology professor from University Hospitals Leuven, shares trial-based perspectives on HER2 strategies. Dr Haley Ellis, medical oncologist at Mass General/Harvard, offers clinical viewpoints on HER2-positive biliary cancers. They discuss managing HER2 treatments with hyperbilirubinemia, cardiac monitoring with HER2 agents, sequencing targeted therapy versus chemoimmunotherapy, and testing choices for overlapping targets.
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Target HER2 Despite Moderate Hyperbilirubinemia
- Use zanidatamab or trastuzumab-based regimens for HER2-positive biliary tract cancer even with moderate hyperbilirubinemia.
- Zanidatamab shows no hepatotoxicity signal and trastuzumab+FOLFOX has tolerable PK, while T-DXd should be used cautiously near moderate hepatic impairment (3.7 T‑bili).
Don’t Let Mild Cardiac Dysfunction Preclude HER2 Therapy
- Consider HER2-targeted agents in patients with reduced ejection fraction when life expectancy is limited, with close monitoring.
- Panelists noted chronic cardiotoxicity risk is less relevant in metastatic biliary cancer but recommend caution, dose reductions, and cardiac monitoring for EF ~40%.
Favor First-Line Trials Over Off-Label HER2 First Use
- Prefer enrolling eligible patients on first-line trials combining HER2 agents with chemotherapy or immunotherapy rather than off-label frontline targeted monotherapy.
- T-DXd and zanidatamab approvals are for previously treated patients, so consider first-line study options if available and guideline chemoimmunotherapy otherwise.