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NCCN Guidelines for Patients


Stomach Cancer, Version 1.2016

NCCN Guidelines for Patients


Stomach Cancer, Version 1.2016


Overview of cancer treatments Clinical trials

Clinical trials

New tests and treatments aren’t offered to the public

as soon as they’re made. They need to be studied.

A clinical trial is a type of research that studies a test

or treatment.

Clinical trials study how safe and helpful tests and

treatments are. When found to be safe and helpful,

they may become tomorrow’s standard of care.

Because of clinical trials, the tests and treatments in

this book are now widely used to help people with

stomach cancer.

New tests and treatments go through a series of

clinical trials to make sure they’re safe and work.

Without clinical trials, there is no way to know if a test

or treatment is safe or helpful. Clinical trials have four

phases. Examples of the four phases for treatment


Phase I

trials aim to find the best dose of a

new drug with the fewest side effects.

Phase II

trials assess if a drug works for a

specific type of cancer.

Phase III

trials compare a new drug to the

standard treatment.

Phase IV

trials test new drugs approved by

the U.S. FDA (


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in many patients with different types of cancer.

Joining a clinical trial has benefits. First, you’ll have

access to the most current cancer care. Second, you

will receive the best management of care. Third, the

results of your treatment—both good and bad—will be

carefully tracked. Fourth, you may help other patients

with cancer.

Clinical trials have risks, too. Like any test or

treatment, there may be side effects. Also, new tests

or treatments may not help. Another downside may

be that paperwork or more trips to the hospital are


To join a clinical trial, you must meet the conditions

of the study. Patients in a clinical trial are often alike

in terms of their cancer and general health. This is to

know that any progress is because of the treatment

and not because of differences between patients.

To join, you’ll need to review and sign a paper called

an informed consent form. This form describes the

study in detail, including the risks and benefits.

Ask your treatment team if there is an open clinical

trial that you can join. There may be clinical trials

where you’re getting treatment or at other treatment

centers nearby. You can also find clinical trials

through the websites listed in Part 6.


Overview of cancer treatments Targeted therapy

HER2 pathway

Cell growth is started by growth signals. HER2 is one

of the surface receptors in stomach cancer cells that

can trigger growth signals. When HER2 attaches to

other receptors, the chemical pathway that sends

growth signals is turned on.

Some people with stomach cancer have too many

HER2s. With too many HER2s, new cancer cells form

quickly. Trastuzumab is a medicine used to stop the

growth signals from HER2s. Research has shown

that it slows down growth of metastatic cancer that

has too many HER2 receptors.


Trastuzumab attaches to the end of HER2 that is

outside of the cell. In doing so, it stops HER2 from

attaching to other surface receptors.

See Figure 15


No growth signals are started.

Trastuzumab is given with chemotherapy. It is given

as an injection into a vein. The drug then travels in

the bloodstream to treat cancer throughout the body.

You may have a mild flu-like response to the first dose

of trastuzumab that includes fever, chills, headache,

muscle aches, and nausea. This response is less

common with the second and third doses. Rare side

effects include damage to the heart or lungs.

Figure 15.

HER2 targeted therapy

Some stomach cancers consists of

cancer cells with too many HER2s.

HER2s trigger growth signals with

cancer cells. Trastuzumab blocks

HER2 from attaching to other

surface receptors and starting

growth signals.

cancer cell


Copyright © 2016 National Comprehensive Cancer Network® (NCCN®).