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What Clinicians Should Know About HER2-Positive Gastric Cancer Treatment and Oral Health

10/15/2026 9:01:00 AM   |   Comments: 0   |   Views: 19

HER2-positive gastric cancer is defined by overexpression or amplification of the human epidermal growth factor receptor 2 (HER2) and occurs in a subset of patients with gastric or gastroesophageal junction (GEJ) adenocarcinoma. HER2 status is determined through biomarker testing of tumor tissue and is an important factor in treatment selection. For patients with HER2-positive advanced or metastatic gastric or GEJ adenocarcinoma, treatment approaches may include HER2-targeted therapies in combination with systemic treatment, depending on clinical characteristics and approved indications. Ongoing assessment of disease status and biomarker results helps inform treatment decisions throughout the course of care. Multidisciplinary management involving oncology specialists, pathologists, and supportive care teams remains an important component of patient treatment and monitoring. Dental professionals may also contribute to supportive care by helping patients maintain oral health and manage dental concerns that arise during cancer treatment.

The HER2 status of a tumor is an important factor for patients with stomach cancer to know about. But the HER2 status in a tumor is only one of many factors that must be taken into consideration when choosing an appropriate treatment approach for a patient. Other factors include the stage of the cancer, other biomarkers found in the patient’s tumors, prior treatments, the patient’s medical problems and the treatment goals of the patient.

Understanding HER2 Testing and Diagnosis

HER2 testing can be performed on a biopsy sample of cancer. Most cancers are tested using two methods of testing: immunohistochemistry (IHC) and in situ hybridization (ISH).

For IHC tested at a score of 2+ for HER2 expression by a pathologist, further testing is required to definitively confirm a HER2-positive gastric cancer. For cases scored as 0 or 1+, HER2 status would be considered negative for HER2 overexpression and testing for other biomarkers would be considered for discussion of possible treatment options.

Your doctor and the rest of your cancer care team should explain the findings of your pathology report to you and how they influenced the decisions regarding your treatment options. For example, your cancer may be tested for other biomarkers (such as PD-L1, and tumor tissue tested for the cancer’s mismatch repair or microsatellite instability, MMR/MSI). If positive, the cancer may be treated with certain types of immunotherapies, including some not approved by FDA.

How Treatment Depends on Cancer Stage

There are distinct her2-positive gastric cancer treatment approaches for localized and metastasized gastric cancer. While for localized cancer the main aim of treatment is the removal of the cancer, for metastasized cancer the focus is on the control of the growth of the cancer, on pain relief, on prolongation of survival and on the maintenance of best possible quality of life with the help of systemic treatments like chemotherapy, targeted therapy and immunotherapy.

For patients with stomach cancer, the goal of treatment is to cure the cancer. That can be achieved by removing the cancer, and often treatments are given prior to surgery to shrink a tumor. Depending on the location of the cancer in the stomach and other factors, a doctor may determine that the patient is a good candidate for surgery and for the use of chemotherapy before surgery.

Metastatic gastric cancer is a cancer that has spread to other parts of the body, such as to organs or tissues. The goal for the treatment of such cancer is to stop the growth of cancer, relieve symptoms and, if possible, prolong the patient’s life and maintain the best possible quality of life by using the systemic (chemotherapy, targeted therapy, or immunotherapy) treatment or treatments based on the characteristics of the tumor and patient’s general condition.

Understanding this distinction can help relieve many of the questions family and friends of gastric cancer patients have when the patient is diagnosed with HER2 positive cancer and goes through treatment for localized or for the metastasized form of the disease.

Targeted Therapy and Other Treatment Options

Trastuzumab is used to treat patients with unresectable or metastatic gastric adenocarcinoma that is HER2-positive. Trastuzumab targets the HER2 protein of cancer cells and interferes with the signal cascade. Chemotherapy has different modes of action in order to kill cancer cells or to prevent their division.

Immunotherapy can be added in some cases. Pembrolizimab in combination with trastuzumab and chemotherapy may be a treatment option in certain cases of gastric cancer, based on the tumor characteristics and in accordance with the relevant treatment guidelines or approvals.

For patients whose cancer has progressed after previously used therapies for HER2-positive stomach cancer, for example trastuzumab, pertuzumab, herceptin-based chemotherapy regimens, in addition to other agents, there are further treatment options available. For example, the antibody-drug conjugate trastuzumab deruxtecan (Dsuviti) may be an option for previously treated HER2-positive patients.

Patients exploring her2 positive stomach cancer treatment should discuss the available therapies, their potential benefits and limitations, and their suitability with their oncologist before making treatment decisions.

When choosing a treatment for her2 positive stomach cancer it is best to get a full list of treatment options with their benefits and limitations and discuss these with your oncologist to see what treatment would be most suitable for you.

Recognizing and Managing Treatment Side Effects

As the person with cancer and also the treating doctor has already mentioned, side effects of treatment of gastric cancer can vary. The person with cancer and also the caring friends and family often notice first, whether symptoms develop. Often it is the caring friends and family that also helps to organize all treatment and to remind the person with cancer of the doses of all the different types of medication.

Chemotherapy can cause fatigue, nausea and vomiting, diarrhea, mouth sores, loss of appetite and reduced blood cells. Trastuzumab can have an effect on the heart. Cardiac function can be checked before and during treatment with trastuzumab.

Side effects caused by the treatment of immunotherapy are immune-related-inflammations of organs such as lung, liver, thyroid or intestines. Trastuzumab deruxtecan can cause interstitial lung disease or pneumonitis. This can become serious fast and has to be recognized fast in order to be treated quickly.

It’s extremely important to report any new or worsening symptoms including new or worsening shortness of breath, cough, fever, diarrhea that is severe, etc. to your oncology team as quickly as possible. Some of these can become serious very quickly and require urgent medical care.

Keep a record of the patient’s symptoms and be present at their oncology appointments. Help manage their medicines and make sure the oncology team are informed of any of the patient’s concerns.

Oral Health and Dental Care During Cancer Treatment

Oral health is another consideration for patients undergoing treatment for gastric cancer. Some cancer treatments can cause mouth sores, dry mouth, changes in taste and inflammation of the oral tissues. These symptoms may make eating, drinking and maintaining daily oral hygiene more difficult.

Maintaining regular oral hygiene, including gentle toothbrushing and cleaning between the teeth as tolerated, can help support oral health during treatment. Patients should inform their oncology team about any mouth sores, oral pain, bleeding gums or other changes in their mouth. A dentist can help assess these concerns and recommend appropriate oral care based on the patient's symptoms and treatment plan.

Before starting cancer treatment, patients may benefit from discussing their dental health with their oncology team. If a dental assessment is needed, the dentist and oncologist can coordinate care, particularly when dental procedures may be affected by treatment-related changes in blood counts, infection risk or healing. Patients should not delay urgent dental care or make changes to their cancer treatment without consulting their healthcare team.

Nutrition, Emotional Support, and Daily Care

Nutritional intake of patients with gastric cancer and receiving treatment for stomach cancer can be affected in different ways. Patients with stomach cancer may experience a decrease in appetite or have difficulty digesting food due to the location of the cancer in the stomach.

A dietitian is able to advise patients of food choices that will sustain them during their treatment, as well as combat weight loss and nutrient deficiency. The amount of fluid to take is also discussed with the patient’s medical team.

Emotional support also is important for gastric cancer patients. Many experience anxiety, fear or fatigue as they go through their treatment, and patients and their caregivers should seek emotional support from others if needed. Counseling and other cancer support services also are available to help patients.

Cancer and its treatment can be very demanding for patients as well as for the people that care for them. Help may come from family and friends as well as from health care professionals as well as from support organizations and more.

Questions Patients and Caregivers Should Ask

There are lots of things that you can ask your oncologist before your appointment, in order to get the most out of it.

What does the HER2 test result mean for the treatment plan?

Is the cancer spread? What is the goal of the treatment now?

Are additional biomarker tests needed?

What side effects should we monitor at home?

How will the treatment response be assessed?

Are clinical trials or other treatment options available?

Who would we contact if we had any symptoms between appointments?

Should I have a dental assessment before starting treatment?

What should I do if I develop mouth sores, dry mouth or other oral health problems during treatment?

Understanding what to expect will allow you and your loved ones to better understand treatment planning and care discussions.

Looking Ahead

There are currently several trials of other treatments for patients with HER2-positive gastric cancer, including other targeted treatments, antibody-drug conjugates and immunotherapy regimens that may help to treat cancer that has become resistant to currently available treatments.

Patients with HER2-positive gastric cancer and their families can support informed treatment discussions and decision-making by knowing the exact diagnosis, strictly following the recommendations of their doctors and reporting all the symptoms. Patients should also communicate with their doctors to define the best possible treatment option in line with individual patients’ needs. Maintaining oral health and seeking dental advice when needed can also form part of supportive care throughout treatment.

Medical Disclaimer

This article is for general information only and should not be used for diagnosis or treatment. The treatment of localized and metastatic gastric cancer can be different and will depend on the cancer stage, biomarker status, patient overall health and the current clinical practice. Consult with an oncologist about the appropriate treatment options. Patients should not start, stop or change any prescribed treatment without consulting with their oncologist first. Patients experiencing oral health problems during cancer treatment should inform their oncology team and seek advice from a qualified dental professional when appropriate.

 

 
Category: Endodontics
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