HEALTH PROFESSIONAL · SOURCE READING

Second-line palliative systemic therapy

Source: Gastric Cancer Treatment (PDQ®)–Health Professional Version, National Cancer Institute.

Source updated: February 21, 2025 · Captured 2026-09-09.

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Context: Treatment of Stage IV, Inoperable, and Recurrent Gastric Cancer / Treatment Options for Stage IV, Inoperable, and Recurrent Gastric Cancer

There is no standard treatment option for patients who develop disease progression after first-line palliative chemotherapy. Accepted regimens include paclitaxel with or without ramucirumab, docetaxel, and irinotecan with or without 5-FU/leucovorin. Pembrolizumab is approved for the treatment of patients with dMMR or MSI-H tumors, and trastuzumab deruxtecan is approved for patients with HER2-positive gastric cancer.

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Palliative chemotherapy →Ramucirumab with or without chemotherapy →Pembrolizumab for patients with dMMR or MSI-H tumors →Trastuzumab deruxtecan for patients with HER2-positive tumors (3+ on IHC or 2+ on IHC with a positive FISH) →

Preserved source evidence · Not medical advice