Molecular Testing in Stage 4 Stomach Cancer in India: A Single-Centre Experience

Introduction Advanced gastric cancer (GC) has a very poor prognosis, and chemotherapy has been the standard of care. The use of immunotherapy or targeted therapy in the stage 4 setting is dependent on molecular testing of the tumour. There is a paucity of data in the Indian scenario on testing for molecular markers in stage 4 GC. Therefore, in this study, we looked at the prevalence of human epidermal growth factor receptor 2 (HER2/neu) expression/amplification, deficient mismatch repair (d-MMR)/microsatellite instability (MSI) high status, and programmed death ligand 1 (PDL-1) status in stage 4 gastric/gastroesophageal junction (GEJ) adenocarcinoma. Methods A retrospective single-centre observational study was conducted between January 2017 and January 2022 of patients diagnosed with stage 4 GC/GEJ adenocarcinoma. Patient data were collected from stored electronic patient records. Data on stage 4 patients who underwent testing for HER2/neu, mismatch repair (MMR)/MSI, and PDL-1 status were recorded. Treatment received was also noted. Results During the study period, 139 patients were diagnosed with stage 4 GC/GEJ adenocarcinoma. HER2/neu testing was done in 99 stage 4 patients (71.2%), with a positivity rate of 16.16% (n = 16). All patients diagnosed as HER2/neu-positive were treated with trastuzumab. Testing of MMR status was carried out in 91 stage 4 patients (65.4%). d-MMR/MSI high was detected in eight patients (8.8%), of which germline MMR was detected as positive in one patient. Five of these eight patients (62.5%) received immune checkpoint inhibitors. PDL-1 testing was done in 61 of the 139 stage 4 patients (43.9%). Twenty patients (32.7%) had PDL-1 tumour proportion score > 1%/combined positive score > 1. Conclusion Molecular profiling has now become the standard while treating late-stage GC. HER2/neu-positive patients have improved survival due to the use of anti-HER2/neu-targeted therapies. It is important to look at not only PDL-1 but also MMR to identify patients who would be eligible and benefit from immunotherapy.