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目前对胃癌中人表皮生长因子受体(2HER2)的预测价值存有争议。当前的治疗指南已经把检测胃癌中HER2状态作为标准化操作。最近,在治疗HER2阳性进展期胃癌中,曲妥珠单抗已经成为一线靶向治疗用药,而原发与继发性药物抵抗则成为主要问题,需要新的治疗策略来克服这种抵抗。许多HER2阳性进展期胃癌患者在接受曲妥珠单抗治疗后都出现疾病进展,必须接受二线方案治疗。新的靶向药物,诸如酪氨酸激酶抑制剂(TKI)拉帕替尼、哺乳动物雷帕霉素靶蛋白(mTOR)通路抑制剂依维莫司、热休克蛋白90(HSP90)抑制剂AUY922、HER二聚化抑制剂帕妥珠单抗以及抗体-药物偶联物曲妥珠单抗-emtansine(T-DM1),在以曲妥珠单抗为基础的一线治疗失败时可以成为二线治疗用药。
The current predictive value of human epidermal growth factor receptor (2HER2) in gastric cancer is controversial. Current treatment guidelines have standardized the detection of HER2 status in gastric cancer. Recently, trastuzumab has become the first-line targeted therapy in the treatment of HER2-positive advanced gastric cancers, while primary and secondary drug resistance have become major issues that require new therapeutic strategies to overcome this resistance. Many patients with advanced HER2-positive advanced gastric cancer develop disease after receiving trastuzumab and must be treated with second-line regimens. New targeted drugs, such as tyrosine kinase inhibitor (TKI), lapatinib, everolimus, a mammalian target of rapamycin (mTOR) pathway, heat shock protein 90 (HSP90) inhibitor AUY922 , The HER dimerization inhibitor pertuzumab, and the antibody-drug conjugate trastuzumab-emtansine (T-DM1), may become second-line therapy when first-line treatment with trastuzumab fails Medication.