Conversion surgery, a procedure intended to convert unresectable tumors to resectable ones, may be underutilized for patients with Stage IV HER2-positive gastric cancer, potentially due to various clinical and economic factors affecting decision-making.
In contemporary gastric oncology practices, advanced HER2-positive cases are frequently steered toward palliative chemotherapy alone, missing a critical window for surgical intervention. Oncologists managing these patients must recognize that robust responses to initial treatment can transform seemingly incurable disease into candidates for potentially curative resections.
Recent real-world outcomes of conversion surgery in HER2-positive gastric cancer shed light on this paradigm shift: patients achieving sufficient tumor regression after trastuzumab-based regimens and combination cytotoxics experienced significantly improved survival, with a 3-year survival rate of 66.7% compared to 20% in those without surgery.
The principle hinge of this approach is effective tumor downsizing. As noted in the earlier report, targeting HER2 receptors with trastuzumab in conjunction with chemotherapy produces significant tumor shrinkage, expanding the cohort eligible for conversion surgery. This evolving treatment paradigm demands careful radiologic and clinical reassessment at defined intervals to identify responders who could benefit from aggressive surgical protocols.
Beyond clinical outcomes, therapeutic decisions in advanced gastric cancer are inseparable from their socioeconomic context. The high costs associated with targeted agents and extended surgical care create tangible burdens for patients and families. Data on financial burden and employment disruption from cancer treatment reveal that out-of-pocket expenses and work interruptions significantly influence adherence, psychological well-being, and long-term quality of life. These non-clinical factors must inform multidisciplinary care pathways and supportive services planning.
Incorporating conversion surgery into treatment algorithms for Stage IV HER2-positive gastric cancer mandates proactive collaboration between medical oncology, surgical teams, and financial counselors, as recommended by current guidelines.
Key Takeaways:- Conversion surgery offers a promising option for managing Stage IV HER2-positive gastric cancer, improving survival rates when combined with effective chemotherapy.
- Targeted shrinking of tumors through trastuzumab-based regimens enhances eligibility for subsequent surgical intervention.
- Financial and employment impacts of advanced treatment significantly affect patient adherence and quality of life, necessitating integrated supportive care planning.