人表皮生长因子受体2阳性晚期胃癌治疗进展
Recent Advances in the Treatment of HER2-Positive Advanced Gastric Cancer
DOI: 10.12677/jcpm.2026.52125, PDF,   
作者: 陶彦冰*：右江民族医学院研究生学院，广西 百色；黄世庆#：右江民族医学院附属医院肿瘤科化疗病区，广西 百色
关键词: 人表皮生长因子受体2阳性；晚期胃癌；Human Epidermal Growth Factor Receptor 2-Positive； Advanced Gastric Cancer
摘要: 胃癌是全球重大公共卫生问题。HER2阳性胃癌是胃癌中一种关键且独特的分子亚型，约占全部胃癌病例的10%~20%。HER2阳性晚期胃癌的一线治疗方案是曲妥珠单抗联合以氟尿嘧啶和铂类为基础的化疗。近年来，随着曲妥珠单抗耐药等因素，帕博利珠单抗(抗PD-1抗体)联合曲妥珠单抗及化疗已成为新的标准一线治疗，显著提高了客观缓解率与无进展生存期。对于一线治疗失败的患者，抗体药物偶联物(ADC)重塑了二线及后续治疗模式。其他药物如雷莫芦单抗(抗VEGFR-2抗体)联合紫杉醇、纳武利尤单抗(抗PD-1抗体)等也在特定人群中获得应用。然而，原发性和获得性耐药是临床面临的主要挑战。针对耐药问题，新型治疗策略不断涌现，包括具有更高效力及“旁观者效应”的新一代ADC、能阻断多重信号的双特异性抗体，以及联合抗血管生成药物或免疫检查点抑制剂等。本文就人表皮生长因子受体2阳性晚期胃癌治疗进展进行综述。
Abstract: Gastric cancer represents a significant global public health challenge. HER2-positive gastric cancer constitutes a crucial and distinct molecular subtype, accounting for approximately 10%~20% of all gastric cancer cases. The first-line treatment for advanced HER2-positive gastric cancer involves trastuzumab combined with fluoropyrimidine and platinum-based chemotherapy. In recent years, due to factors such as trastuzumab resistance, the combination of pembrolizumab (an anti-PD-1 antibody) with trastuzumab and chemotherapy has emerged as a new standard first-line regimen, significantly improving objective response rates and progression-free survival. For patients who experience first-line treatment failure, antibody-drug conjugates (ADCs) have reshaped the landscape of second-line and subsequent therapies. Other agents, such as ramucirumab (an anti-VEGFR-2 antibody) combined with paclitaxel, and nivolumab (an anti-PD-1 antibody), have also demonstrated utility in specific patient populations. However, primary and acquired resistance remain major clinical challenges. To address resistance, novel therapeutic strategies are continuously emerging. These include next-generation ADCs with enhanced potency and a “bystander effect,” bispecific antibodies capable of blocking multiple signaling pathways, and combinations with anti-angiogenic agents or immune checkpoint inhibitors, among others. This article reviews the recent advances in the treatment of human epidermal growth factor receptor 2 (HER2)-positive advanced gastric cancer.
文章引用：陶彦冰, 黄世庆. 人表皮生长因子受体2阳性晚期胃癌治疗进展[J]. 临床个性化医学, 2026, 5(2): 265-278. https://doi.org/10.12677/jcpm.2026.52125

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