Trastuzumab, Bevacizumab with Paclitaxel for HER2-positive Gastric Cancer in a Second-line Therapy

Inclusion Criteria:

1. HER2-positive advanced gastric cancer

• Defined as IHC 2+, which is IHC 3+ or SISH + (or FISH) evaluated by laboratorytests. (SISH positivity is defined as the ratio of the HER2 gene copy number tothe CEP17 signal ≥ 2.0)

• or significant overexpression of HER2 protein on target proteomic analysis (multiple reaction monitoring)

2. Patients who have progressed in response to one systemic anticancer therapy foradvanced gastric cancer

3. Patients who are willing and able to write a written consent form for this trial.

4. Patients aged 19 years or older at the time of signing the subject consent form.

5. Patients with measurable or evaluable lesions according to RECIST 1.1.

6. ECOG activity status 0, 1 or 2

7. as patients with adequate organ function

• Absolute neutrophil (ANC) ≥1.0 x 109/L, platelet ≥100 x 109/L, hemoglobin ≥9g/dL, serum creatinine ≤1.5 x ULN, total bilirubin ≤3.0 mg on laboratory testswithin 2 weeks before starting treatment /dL, AST/ALT ≤5 x ULN

• Echocardiogram EF ≥55% or MUGA scan ≥50%

Exclusion Criteria:

1. Patients who have received chemotherapy, radiation therapy, immunotherapy ortargeted therapy for gastric cancer within the past 2 weeks.

2. Patients who have experienced Grade 3-4 gastrointestinal bleeding within 3 months

3. Patients who have experienced an arteriovascular embolism event, including but notlimited to myocardial infarction, transient ischemic attack, cerebrovasculardisorder, or unstable angina within 6 months

4. Ongoing or active infection, symptomatic congestive heart failure, unstable angina,symptomatic or poorly controlled cardiac arrhythmias, uncontrolled thrombotic orhemorrhagic disorders, or any other serious medical disorder not controlled in theinvestigator's judgment patient with

5. Patients with a history of gastrointestinal perforation or fistula within 6 months.

6. Concomitant diagnosis of cancer in another site or history of active malignant tumorwithin the past 3 years

• Excluding fully cured basal cell carcinoma and thyroid cancer, in situ cervicalcancer