内容紹介
A Case of Advanced Gastric Cancer with Multiple Liver, Lung, and Lymph Node Metastases Treated with S-1, CDDP, and Trastuzumab
Summary
The patient was a 58-year-old man diagnosed with type 2 advanced gastric cancer located at the fundus with multiple liver, lung, and lymph node metastases(Stage Ⅳ). Examination of an endoscopically obtained biopsy specimen revealed poorly differentiated adenocarcinoma(por), which stained positive for human epidermal growth factor receptor 2(HER2)on immunohistochemistry. We started chemotherapy with S-1 plus cisplatin(CDDP)plus trastuzumab. The treatment was effective, as the tumor had reduced in size by 22.5% and 36.2%(partial response[PR])after 3 and 6 courses, respectively. Adverse events related to the treatment were limited to grade 1 fever, nausea, vomiting, and diarrhea. The patient's chief complaints of right upper abdominal pain and abdominal fullness remarkably improved after treatment initiation. Although the therapy was effective against the multiple liver metastases and could be continued for 11 courses, the lymph nodes metastases did not respond to therapy(progressive disease[PD]), and the patient died 9 months after the start of treatment. Chemotherapy with S-1 pus CDDP plus trastuzumab may be effective for HER2-positive advanced gastric cancer with liver metastasis.
要旨
症例は58歳,男性。診断は噴門部の2型腫瘍で同時性に多発性肝・肺・リンパ節転移を伴っており,Stage Ⅳ進行胃癌であった。生検の結果は低分化型腺癌で,HER2が3+(IHC法)と陽性であった。そこでS-1+CDDP+trastuzumabの3剤併用による化学療法を適用した。3コースにて22.5%の縮小率が得られ,6コース後の再検にてPR(36.2%縮小)となった。有害事象はgrade 1の発熱,嘔気,嘔吐,下痢のみであった。右上腹部痛および腹部膨満の症状も著しく改善した。結果的に肝転移に対しては著効したが,リンパ節転移には効果なく11コース後の9か月目に原病死した。HER2陽性進行胃癌,特に肝転移を有する例に対してS-1+CDDP+trastuzumabによる化学療法は,有効なレジメンである可能性が示唆された。
目次
Summary
The patient was a 58-year-old man diagnosed with type 2 advanced gastric cancer located at the fundus with multiple liver, lung, and lymph node metastases(Stage Ⅳ). Examination of an endoscopically obtained biopsy specimen revealed poorly differentiated adenocarcinoma(por), which stained positive for human epidermal growth factor receptor 2(HER2)on immunohistochemistry. We started chemotherapy with S-1 plus cisplatin(CDDP)plus trastuzumab. The treatment was effective, as the tumor had reduced in size by 22.5% and 36.2%(partial response[PR])after 3 and 6 courses, respectively. Adverse events related to the treatment were limited to grade 1 fever, nausea, vomiting, and diarrhea. The patient's chief complaints of right upper abdominal pain and abdominal fullness remarkably improved after treatment initiation. Although the therapy was effective against the multiple liver metastases and could be continued for 11 courses, the lymph nodes metastases did not respond to therapy(progressive disease[PD]), and the patient died 9 months after the start of treatment. Chemotherapy with S-1 pus CDDP plus trastuzumab may be effective for HER2-positive advanced gastric cancer with liver metastasis.
要旨
症例は58歳,男性。診断は噴門部の2型腫瘍で同時性に多発性肝・肺・リンパ節転移を伴っており,Stage Ⅳ進行胃癌であった。生検の結果は低分化型腺癌で,HER2が3+(IHC法)と陽性であった。そこでS-1+CDDP+trastuzumabの3剤併用による化学療法を適用した。3コースにて22.5%の縮小率が得られ,6コース後の再検にてPR(36.2%縮小)となった。有害事象はgrade 1の発熱,嘔気,嘔吐,下痢のみであった。右上腹部痛および腹部膨満の症状も著しく改善した。結果的に肝転移に対しては著効したが,リンパ節転移には効果なく11コース後の9か月目に原病死した。HER2陽性進行胃癌,特に肝転移を有する例に対してS-1+CDDP+trastuzumabによる化学療法は,有効なレジメンである可能性が示唆された。