Patient Conversations, Global Trial Representation, and Closing Thoughts on HER2-Positive GEA

In this closing episode, Dr. Wainberg, Dr. Shameem, Dr. Elimova, and Dr. Shah cover patient conversations, global trial representation, and where the field is heading.

Dr. Shameem notes that many patients arrive already informed, sometimes after consulting tools like ChatGPT, which he finds reasonably accurate at synthesizing data. His approach: acknowledge the historically poor prognosis, offer FDA-approved therapies, and personalize treatment selection based on toxicity tolerance and patient goals. Dr. Wainberg adds that it is better to have more options than fewer, even if decisions get harder.

On trial representation, Dr. Wainberg notes that US sites did not participate in HERIZON-GEA-01 and argues that Western patients need to be represented in global programs rather than simply extrapolating Asian data. Dr. Elimova agrees that Western sites, including Canada, are sometimes underestimated for enrollment capacity and advocates for US, Canada, and Europe collaboration. The panel also notes that HER2-directed agents are moving into earlier settings, including preoperative and nonoperative management.

Dr. Shah highlights two areas of excitement. First, HER2-directed CAR-T therapy and immune activation strategies, including the rilvegostomig (PD-1/TIGIT bispecific) arm of ARTEMIDE-Gastric01. Second, the emerging challenge of long-term survivors developing brain metastases, for which he has used tucatinib plus trastuzumab off-label. Dr. Wainberg similarly tapers chemotherapy and maintains patients on antibody-based regimens for extended periods. He closes the Peer Exchange by thanking the panel and the audience.

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