The UK's National Institute for Health and Clinical Excellence (NICE) has recommended trastuzumab (Herceptin, Roche Products) in combination with cisplatin and either capecitabine or 5-fluorouracil as an option for certain patients with metastatic adenocarcinoma of the stomach and gastro-oesophageal junction who have high levels of human epidermal growth factor receptor 2 (HER2). In final guidance published yesterday, NICE has recommended trastuzumab, in combination with cisplatin and capecitabine or 5-fluorouracil, for the treatment of people with HER2-positive, metastatic adenocarcinoma of the stomach or gastro-oesophageal junction who have not received prior treatment for their metastatic disease and whose tumours express high levels of HER2 as defined by a positive immunohistochemistry score of 3 (IHC3 positive).

HER2 is a protein found on the surface of some cancer cells. Trastuzumab attaches itself to the protein so that epidermal growth factor production is reduced in the cancer cells; this stops the cells from dividing and growing.

Dr Carole Longson, Health Technology Evaluation Centre Director at NICE said: "We are very pleased to be able to recommend trastuzumab for patients with gastric cancer who have very high levels of HER2. This new guidance is good news for patients. The average life expectancy for people with metastatic gastric cancer is around one year. Although trastuzumab is not a cure, it has the potential to extend the lives of those patients with high levels of HER2 by more than three months."

During consultation on the first draft guidance, Roche Products, the manufacturer of trastuzumab, submitted a new analysis on a subgroup of patients with the highest levels of HER2. The Committee discussed this new information in the context of the supplementary advice to the Committee on appraising a life-extending, end-of-life treatment and concluded that trastuzumab was cost-effective in this patient group.

Source: National Institute for Health and Clinical Excellence