Appointment sheet
Gastric & gastro-oesophageal junction cancer
Prepared with OnCo (onco.cc/prep/gastric/). Orientation, not medical advice; your team knows your case.
My details
Name
Date of appointment
Hospital and clinician
Who is coming with me
What I know, what is unclear, changes to discuss
Saved in this browserWhat I know so far
What is unclear to me
Changes since last time
My questions
42 on the sheetNewly diagnosed
- 1.What is my exact diagnosis, stage, and grade, and which tests established them?
- 2.Which biomarkers have been tested on my tumour (for example HER2, PD-L1 CPS, CLDN18.2, MSI, FGFR2b), and what were the results?
- 3.Which subtype is my cancer, and does that change the recommended treatment?
- 4.Is germline (inherited) genetic testing recommended for me or my family?
Localised
- 5.For my situation (localised), which of the standard options do you recommend and why?
- 6.Am I a candidate for Durvalumab, and what side effects should I expect?
Advanced first line
- 7.For my situation (advanced first line), which of the standard options do you recommend and why?
- 8.Am I a candidate for Nivolumab, Pembrolizumab, Trastuzumab, and what side effects should I expect?
Later lines
- 9.For my situation (later lines), which of the standard options do you recommend and why?
- 10.Am I a candidate for Trastuzumab deruxtecan, Zanidatamab, Satricabtagene autoleucel or related drugs, and what side effects should I expect?
Prevention and screening
- 11.For my situation (prevention and screening), which of the standard options do you recommend and why?
Early (T1a) disease
- 12.For my situation (early (t1a) disease), which of the standard options do you recommend and why?
Resectable stage II-III (Western)
- 13.For my situation (resectable stage ii-iii (western)), which of the standard options do you recommend and why?
- 14.Am I a candidate for FLOT (5-FU, leucovorin, oxaliplatin, docetaxel), Durvalumab, CAPOX (capecitabine, oxaliplatin), and what side effects should I expect?
- 15.How do the results of MATTERHORN apply to someone like me?
Resectable stage II-III (Asian practice)
- 16.For my situation (resectable stage ii-iii (asian practice)), which of the standard options do you recommend and why?
- 17.Am I a candidate for CAPOX (capecitabine, oxaliplatin), and what side effects should I expect?
Advanced, HER2-positive, first line
- 18.For my situation (advanced, her2-positive, first line), which of the standard options do you recommend and why?
- 19.Am I a candidate for Trastuzumab, Zanidatamab, Pembrolizumab or related drugs, and what side effects should I expect?
- 20.How do the results of ToGA and HERIZON-GEA-01 apply to someone like me?
Advanced, HER2-negative, PD-L1 CPS ≥5 (or ≥1), first line
- 21.For my situation (advanced, her2-negative, pd-l1 cps ≥5 (or ≥1), first line), which of the standard options do you recommend and why?
- 22.Am I a candidate for Nivolumab, Pembrolizumab, Tislelizumab or related drugs, and what side effects should I expect?
- 23.How do the results of CheckMate 649 and KEYNOTE-859 apply to someone like me?
Advanced, CLDN18.2-positive (≥75%), HER2-negative, first line
- 24.For my situation (advanced, cldn18.2-positive (≥75%), her2-negative, first line), which of the standard options do you recommend and why?
- 25.Am I a candidate for Zolbetuximab, FOLFOX (5-FU, leucovorin, oxaliplatin), CAPOX (capecitabine, oxaliplatin), and what side effects should I expect?
- 26.How do the results of SPOTLIGHT & GLOW apply to someone like me?
Advanced, HER2-negative, PD-L1 CPS <1 and CLDN18.2-negative
- 27.For my situation (advanced, her2-negative, pd-l1 cps <1 and cldn18.2-negative), which of the standard options do you recommend and why?
- 28.Am I a candidate for FOLFOX (5-FU, leucovorin, oxaliplatin), CAPOX (capecitabine, oxaliplatin), and what side effects should I expect?
Second line, HER2-positive
- 29.For my situation (second line, her2-positive), which of the standard options do you recommend and why?
- 30.Am I a candidate for Trastuzumab deruxtecan, and what side effects should I expect?
- 31.How do the results of DESTINY-Gastric04 apply to someone like me?
Second line, HER2-negative
- 32.For my situation (second line, her2-negative), which of the standard options do you recommend and why?
- 33.Am I a candidate for Ramucirumab, Paclitaxel / nab-paclitaxel, Sonesitatug vedotin or related drugs, and what side effects should I expect?
- 34.How do the results of RAINBOW and CLARITY-Gastric 01 apply to someone like me?
Third line and beyond
- 35.For my situation (third line and beyond), which of the standard options do you recommend and why?
- 36.Am I a candidate for Trifluridine/tipiracil, and what side effects should I expect?
Peritoneal metastases
- 37.For my situation (peritoneal metastases), which of the standard options do you recommend and why?
Any stage
- 38.Are there clinical trials I could join, for example of Sonesitatug vedotin, Satricabtagene autoleucel, Disitamab vedotin, Zanidatamab?
- 39.Would a second opinion at a high-volume centre change anything, and can you help arrange it?
- 40.What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
- 41.I read that “Peritoneal metastasis”. How does that affect my plan?
- 42.I read that “Heterogeneous CLDN18.2/HER2 expression”. How does that affect my plan?
The words I may hear
- Lauren classification (intestinal vs diffuse): Stomach cancers come in two main shapes: intestinal (gland-forming, linked to H.
- ADCC (antibody-dependent cellular cytotoxicity): In ADCC, an antibody flags a cell, and NK cells recognise the flag and kill it.
- Interstitial lung disease (ILD) / pneumonitis: Interstitial lung disease (ILD) is lung inflammation, a serious side effect of some ADCs (especially Enhertu) and immunotherapy.
- FLOT regimen (perioperative chemotherapy for gastric cancer): Four cycles of chemotherapy before and four after surgery for stomach and junction cancer, using fluorouracil, leucovorin, oxaliplatin and docetaxel.
- Oesophagectomy: Surgery that removes most of the food pipe (oesophagus) and rebuilds it by pulling the stomach up into the chest.
- Intraperitoneal (IP) chemotherapy: Delivering chemotherapy directly into the abdominal cavity through a catheter, so the tumour deposits on the lining get a far higher dose than the rest of the body would tolerate.
- Gastrectomy: Removing part (subtotal) or all (total) of the stomach for stomach cancer, with the bowel joined to what remains.
- Gastro-oesophageal junction (GEJ): Where the food pipe meets the stomach.
- Siewert classification (GEJ tumours): A way of classifying cancers at the junction of the oesophagus and stomach by where their centre sits, which decides whether they are treated as oesophageal or gastric.
- Cancer cachexia: Severe loss of weight and muscle in advanced cancer that eating more cannot reverse on its own.
Tests and results to bring
Biomarker results to ask for: HER2, PD-L1 CPS, CLDN18.2, MSI, FGFR2b, EBV, HER2 IHC/ISH (all advanced cases), PD-L1 CPS (22C3 or 28-8), CLDN18.2 IHC (VENTANA 43-14A; ≥75% 2+/3+), MSI/dMMR, EBV (EBER in situ hybridisation), FGFR2b IHC (trials), Germline CDH1 in diffuse type or family history, Staging laparoscopy with peritoneal cytology, ctDNA (trials).
Scans and tests linked to this cancer: Companion diagnostics, Cytogenetics and FISH, DPYD genotyping and DPD phenotyping before fluoropyrimidines, Endoscopic resection (EMR / ESD), Endoscopic ultrasound and EBUS systems, Gastric cancer endoscopic screening (East Asia).
Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.
The treatments I may be offered
- Prevention and screening: H. pylori eradication reduces incidence; endoscopic screening programmes in Japan and Korea (biennial from age 40-50) detect most cancers at a curable stage. No population screening in the West. Prophylactic total gastrectomy for germline CDH1 carriers. (Chemoprevention & risk-reducing surgery, Germline (hereditary) testing)
- Localised: Perioperative FLOT ± durvalumab; D2 gastrectomy. (Durvalumab, Robotic & minimally invasive surgery)
- Early (T1a) disease: Endoscopic submucosal dissection for well-differentiated mucosal tumours ≤2 cm without ulceration (expanded criteria in Japan); otherwise gastrectomy. (Endoscopic resection (EMR / ESD))
- Resectable stage II-III (Western): Perioperative FLOT + durvalumab (MATTERHORN: OS HR 0.78, pCR 19%) with D2 gastrectomy; FOLFOX/CAPOX perioperatively for patients unfit for docetaxel. (MATTERHORN, FLOT (5-FU, leucovorin, oxaliplatin, docetaxel), Durvalumab, CAPOX (capecitabine, oxaliplatin))
- Resectable stage II-III (Asian practice): D2 gastrectomy then adjuvant S-1 (ACTS-GC) or CAPOX (CLASSIC) for 6-12 months; neoadjuvant approaches increasingly adopted. (CAPOX (capecitabine, oxaliplatin))
- Advanced first line: Chemotherapy + PD-1 ± trastuzumab ± zolbetuximab by biomarker. (Nivolumab, Pembrolizumab, Trastuzumab)
- Advanced, HER2-positive, first line: Trastuzumab + fluoropyrimidine/platinum + pembrolizumab (KEYNOTE-811, PD-L1 CPS ≥1); zanidatamab + chemotherapy ± tislelizumab after HERIZON-GEA-01 (PFS 12.4 vs 8.1 months; sBLA 2026). (ToGA, HERIZON-GEA-01, Trastuzumab, Zanidatamab, Pembrolizumab, Tislelizumab, HER2 sequence in gastric cancer: zanidatamab/trastuzumab + chemo ± PD-1 → T-DXd)
- Advanced, HER2-negative, PD-L1 CPS ≥5 (or ≥1), first line: Nivolumab (CheckMate 649) or pembrolizumab (KEYNOTE-859) or tislelizumab (RATIONALE-305) with FOLFOX or CAPOX; add zolbetuximab if CLDN18.2-positive (sequencing/combination under study). (CheckMate 649, KEYNOTE-859, Nivolumab, Pembrolizumab, Tislelizumab, FOLFOX (5-FU, leucovorin, oxaliplatin), CAPOX (capecitabine, oxaliplatin))
- Advanced, CLDN18.2-positive (≥75%), HER2-negative, first line: Zolbetuximab + mFOLFOX6 or CAPOX (SPOTLIGHT/GLOW). PD-L1 CPS ≥5 double-positives: either add-on; combination trials ongoing. (SPOTLIGHT & GLOW, Zolbetuximab, FOLFOX (5-FU, leucovorin, oxaliplatin), CAPOX (capecitabine, oxaliplatin), Biomarker-directed first-line quadruplets in gastric cancer)
- Advanced, HER2-negative, PD-L1 CPS <1 and CLDN18.2-negative: FOLFOX or CAPOX chemotherapy alone; MSI-high tumours get PD-1 blockade regardless of CPS. (FOLFOX (5-FU, leucovorin, oxaliplatin), CAPOX (capecitabine, oxaliplatin), Microsatellite instability (MSI-H) / mismatch repair deficiency (dMMR))
- Peritoneal metastases: Systemic therapy; intraperitoneal paclitaxel, HIPEC, and PIPAC in trials; palliative gastrectomy not recommended (REGATTA). (Peritoneal metastasis, HIPEC / PIPAC (intraperitoneal chemotherapy), Peritoneal-directed therapy for gastric cancer)
- Later lines: T-DXd (HER2+), zanidatamab, CLDN18.2 CAR-T/ADC in trials. (Trastuzumab deruxtecan, Zanidatamab, Satricabtagene autoleucel, Sonesitatug vedotin)
- Second line, HER2-positive: Trastuzumab deruxtecan 6.4 mg/kg (DESTINY-Gastric04, OS 14.7 vs 11.4 months) if HER2 persists on re-biopsy or ctDNA. (DESTINY-Gastric04, Trastuzumab deruxtecan)
- Second line, HER2-negative: Ramucirumab + paclitaxel (RAINBOW, OS 9.6 vs 7.4 months); CLDN18.2-positive: sonesitatug vedotin after CLARITY-Gastric 01 (2026) or satri-cel CAR-T (China). (RAINBOW, Ramucirumab, Paclitaxel / nab-paclitaxel, CLARITY-Gastric 01, Sonesitatug vedotin, Satricabtagene autoleucel, CLDN18.2 antibody first line → CLDN18.2 ADC or CAR-T on progression)
- Third line and beyond: Trifluridine/tipiracil (TAGS, OS 5.7 vs 3.6 months); irinotecan; clinical trials (FGFR2b, CLDN18.2 bispecifics, T-cell engagers). (Trifluridine/tipiracil)
From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.
Answers and next steps
Saved in this browserWhat I was told
Agreed next steps, dates and who to call