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This combination regimen, often referred to as mDCF plus trastuzumab, is a chemo-immunotherapy protocol evaluated by Memorial Sloan Kettering Cancer Center for the treatment of HER2-positive unresectable or metastatic gastric and gastroesophageal junction (GEJ) adenocarcinoma. The regimen consists of the monoclonal antibody trastuzumab, which targets the human epidermal growth factor receptor 2 (HER2), combined with a modified docetaxel, cisplatin, and fluorouracil (mDCF) chemotherapy backbone. The modification (mDCF) is designed to reduce the significant toxicities associated with the standard DCF regimen while maintaining therapeutic efficacy. Trastuzumab works by binding to the extracellular domain of HER2, inhibiting downstream proliferative signaling and inducing antibody-dependent cellular cytotoxicity (ADCC). The chemotherapy components provide synergistic cytotoxic effects by disrupting microtubule function (docetaxel), inducing DNA cross-linking (cisplatin), and inhibiting thymidylate synthase (fluorouracil, modulated by leucovorin).
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