title: HER2 Testing and Clinical Decision Making in Gastroesophageal Adenocarcinoma: Guideline From the College of American Pathologists, American Society for Clinical Pathology, and American Society of Clinical Oncology.
abstract: BACKGROUND
  - ERBB2 (erb-b2 receptor tyrosine kinase 2 or HER2) is currently the only biomarker established for selection of a specific therapy for patients with advanced gastroesophageal adenocarcinoma (GEA). However, there are no comprehensive guidelines for the assessment of HER2 in patients with GEA.
  
  
  OBJECTIVE
  - To establish an evidence-based guideline for HER2 testing in patients with GEA, to formalize the algorithms for methods to improve the accuracy of HER2 testing while addressing which patients and tumor specimens are appropriate, and to provide guidance on clinical decision making.
  
  
  METHODS
  - The College of American Pathologists, American Society for Clinical Pathology, and American Society of Clinical Oncology convened an expert panel to conduct a systematic review of the literature to develop an evidence-based guideline with recommendations for optimal HER2 testing in patients with GEA.
  
  
  RESULTS
  - The panel is proposing 11 recommendations with strong agreement from the open-comment participants.
  
  
  CONCLUSIONS
  - The panel recommends that tumor specimen(s) from all patients with advanced GEA, who are candidates for HER2-targeted therapy, should be assessed for HER2 status before the initiation of HER2-targeted therapy. Clinicians should offer combination chemotherapy and a HER2-targeted agent as initial therapy for all patients with HER2-positive advanced GEA. For pathologists, guidance is provided for morphologic selection of neoplastic tissue, testing algorithms, scoring methods, interpretation and reporting of results, and laboratory quality assurance.
  
  
  CONCLUSIONS
  - This guideline provides specific recommendations for assessment of HER2 in patients with advanced GEA while addressing pertinent technical issues and clinical implications of the results.
authors.affiliation: From the Department of Pathology, St. Joseph Mercy Hospital, Ann Arbor, Michigan (Dr Bartley); the Department of Pathology, Vanderbilt University Medical Center, Nashville, Tennessee (Dr Washington); Surveys (Ms Ventura) and Governance (Ms Colasacco), College of American Pathologists, Northfield, Illinois; Quality and Guidelines Department, American Society of Clinical Oncology, Alexandria, Virginia (Dr Ismaila); the Division of Hematology/Oncology, Northwestern University, Chicago, Illinois (Dr Benson); Medical Oncology Department, Ramon y Cajal University Hospital, Madrid, Spain (Dr Carrato); the Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill (Dr Gulley); the Department of Pathology, Yale University School of Medicine, New Haven, Connecticut (Dr Jain); the Department of Pathology and Laboratory Medicine, UCSF, San Francisco, California (Dr Kakar); the Division of Medical Oncology and Hematology, University of Toronto/Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada (Dr Mackay); the Department of Laboratory Medicine, St. Michael's Hospital, Toronto, Ontario, Canada (Dr Streutker); the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Dr Tang); the Department of Pathology, Stanford University Medical Center, Stanford, California (Dr Troxell); and the Department of Gastrointestinal Medical Oncology, University of Texas MD Anderson Cancer Center, Houston (Dr Ajani).
authors.forename: Angela N
authors.initials: AN
authors.lastname: Bartley
authors.forename: Mary Kay
authors.initials: MK
authors.lastname: Washington
authors.forename: Christina B
authors.initials: CB
authors.lastname: Ventura
authors.forename: Nofisat
authors.initials: N
authors.lastname: Ismaila
authors.forename: Carol
authors.initials: C
authors.lastname: Colasacco
authors.forename: Al B
authors.initials: AB
authors.lastname: Benson
authors.forename: Alfredo
authors.initials: A
authors.lastname: Carrato
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Gulley
authors.forename: Dhanpat
authors.initials: D
authors.lastname: Jain
authors.forename: Sanjay
authors.initials: S
authors.lastname: Kakar
authors.forename: Helen J
authors.initials: HJ
authors.lastname: Mackay
authors.forename: Catherine
authors.initials: C
authors.lastname: Streutker
authors.forename: Laura
authors.initials: L
authors.lastname: Tang
authors.forename: Megan
authors.initials: M
authors.lastname: Troxell
authors.forename: Jaffer A
authors.initials: JA
authors.lastname: Ajani
mesh_terms: D006801:Humans; D000230:Adenocarcinoma / Q000175:diagnosis / Q000235:genetics / Q000378:metabolism / Q000628:therapy; D014408:Biomarkers, Tumor / Q000235:genetics / Q000378:metabolism; D000066491:Clinical Decision-Making; D003131:Combined Modality Therapy; D003663:Decision Trees; D003937:Diagnosis, Differential; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000235:genetics / Q000378:metabolism / Q000628:therapy; D019317:Evidence-Based Medicine; D008495:Medical Oncology / Q000379:methods / Q000639:trends; D025202:Molecular Diagnostic Techniques / Q000592:standards; D058990:Molecular Targeted Therapy; D009154:Mutation; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D010338:Pathology, Clinical / Q000379:methods / Q000639:trends; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000037:antagonists & inhibitors / Q000235:genetics / Q000378:metabolism; D012955:Societies, Medical; D013274:Stomach Neoplasms / Q000175:diagnosis / Q000235:genetics / Q000378:metabolism / Q000628:therapy; D014481:United States; D000078202:Systematic Reviews as Topic
chemical_list: D014408:Biomarkers, Tumor; D018719:Erb-b2 Receptor Tyrosine Kinases; C508053:ERBB2 protein, human