title: Trastuzumab in Esophagogastric Cancer: HER2-Testing and Treatment Reality outside Clinical Studies in Germany.
abstract: We analysed trends over time in palliative first-line chemotherapy in patients with locally advanced or metastatic esophagogastric cancer. Special focus was on frequency and quality of HER2-testing and trends in drug use in combination with trastuzumab. Earlier published data about patients treated outside clinical studies showed a relatively low rate of HER2-testing and insufficient test quality. A total of 2,808 patients retrospectively documented in Therapiemonitor (®) from 2006 to 2013 were analysed regarding treatment intensity and trends in used drugs. Data on HER2-testing and therapies were analysed in two cohorts documented in 2010 and 2011 (1) compared to 2012 and 2013 (2). Treatment intensity increased: 49.3% of patients received at least a triplet in 2013 compared to 10.1% in 2006. In cohort 2 HER2 expression was tested in 79.1% of the cases. Still, in 26.9% testing was not done as requested by guidelines. Good performance status, multiple metastases, age ≤ 65 years, the objective "to prevent progression," good cognitive capabilities, estimated good compliance, and social integration positively influenced the probability of HER2-testing; comorbidities negatively affected it. Usage of the combination of fluoropyrimidines and cisplatin with trastuzumab declined from 67% in cohort 1 to 50% in cohort 2.
authors.affiliation: TagesTherapieZentrum am Interdisziplinären Tumorzentrum Mannheim und III. Medizinische Klinik, Hämatologie und Onkologie, Universitätsmedizin Mannheim, Universität Heidelberg, 68167 Mannheim, Germany.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Merx
authors.affiliation: Marienhospital Darmstadt, Klinik für Innere Medizin, 64285 Darmstadt, Germany.
authors.forename: Manuel
authors.initials: M
authors.lastname: Barreto Miranda
authors.affiliation: Oncology Information Service (OIS), 79098 Freiburg, Germany.
authors.forename: Lenka
authors.initials: L
authors.lastname: Kellermann
authors.affiliation: St. Lukas Klinik, Abteilung für Onkologie und Hämatologie, Ohligs, 42697 Solingen, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Mahlknecht
authors.affiliation: Gemeinschaftspraxis für Strahlentherapie-Bonn-Rhein-Sieg, Bonn, 53177 Bad Godesberg, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Lange
authors.affiliation: Evangelisches Klinikum Niederrhein gGmbH, 47169 Duisburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Gonnermann
authors.affiliation: TagesTherapieZentrum am Interdisziplinären Tumorzentrum Mannheim und III. Medizinische Klinik, Hämatologie und Onkologie, Universitätsmedizin Mannheim, Universität Heidelberg, 68167 Mannheim, Germany.
authors.forename: Ralf-Dieter
authors.initials: RD
authors.lastname: Hofheinz