内容紹介
A Case of HER2-Positive Advanced Gastric Cancer Successfully Treated via Capecitabine, Cisplatin, and Trastuzumab Combination Chemotherapy
Summary
We report a case of human epidermal growth factor receptor 2(HER2)-positive advanced gastric cancer effectively treated via capecitabine, cisplatin, and trastuzumab(XPT)chemotherapy followed by curative gastrectomy. The patient was a 66-year-old man with type 2 gastric cancer in the greater curvature of the gastric angle. Biopsy revealed that the tumor was a well or moderately differentiated adenocarcinoma, and immunohistochemistry showed positive expression of HER2(3+). Chest and abdominal computed tomography(CT)showed a liver tumor 21×9 mm in size in the caudate lobe and swollen lymph nodes in the paragastric, para-aortic, and left supraclavicular regions. After 4 courses of XPT, a clinical complete response was obtained. The patient received additional 13 courses of trastuzumab and capecitabine and underwent BillrothⅠ distal gastrectomy with D2 lymph node dissection and resection of the para-aortic and left supraclavicular lymph nodes. Liver metastasis was not detected. No residual cancer cells were found in the stomach or lymph nodes except for the left supraclavicular lymph nodes. Pathological classification according to the Japanese Classification of Gastric Carcinoma, 14 th edition, was ypT0, ypN0, ypM1(LYM), Grade 2, ypStage Ⅳ. The patient developed a post-operative anastomotic leakage that required drainage via laparotomy, but was discharged 76 days after surgery in good condition.
要旨 HER2陽性進行胃癌に対しcapecitabine+cisplatin+trastuzumab(XPT)療法を施行し臨床的完全奏効が得られ,R0切除を行い得た症例を経験したので報告する。症例は66歳,男性。胃角部大弯前壁に2型腫瘍を認め,生検でtub1-2,HER2: 3+。CTでは肝S1に21×9 mmの腫瘍を認め,3b,4d,16a2,16b1,左鎖骨上(Virchow)リンパ節は腫大していた。XPT療法を4コース施行したところ,臨床的完全奏効が得られた。以後capecitabine+trastuzumabのみ13コース継続し,手術を行った。幽門側胃切除D2郭清Billroth Ⅰ法再建,16a2,16b1,Virchowリンパ節摘出を行った。肝転移は認めなかった。摘出胃と領域リンパ節には病理組織学的悪性所見を認めなかったが,Virchowリンパ節に転移を認めた。病理所見はypT0,ypN0,ypM1(LYM),Grade 2,ypStage Ⅳであった。術後縫合不全を生じ開腹ドレナージを要したが,76日目に退院した。
目次
Summary
We report a case of human epidermal growth factor receptor 2(HER2)-positive advanced gastric cancer effectively treated via capecitabine, cisplatin, and trastuzumab(XPT)chemotherapy followed by curative gastrectomy. The patient was a 66-year-old man with type 2 gastric cancer in the greater curvature of the gastric angle. Biopsy revealed that the tumor was a well or moderately differentiated adenocarcinoma, and immunohistochemistry showed positive expression of HER2(3+). Chest and abdominal computed tomography(CT)showed a liver tumor 21×9 mm in size in the caudate lobe and swollen lymph nodes in the paragastric, para-aortic, and left supraclavicular regions. After 4 courses of XPT, a clinical complete response was obtained. The patient received additional 13 courses of trastuzumab and capecitabine and underwent BillrothⅠ distal gastrectomy with D2 lymph node dissection and resection of the para-aortic and left supraclavicular lymph nodes. Liver metastasis was not detected. No residual cancer cells were found in the stomach or lymph nodes except for the left supraclavicular lymph nodes. Pathological classification according to the Japanese Classification of Gastric Carcinoma, 14 th edition, was ypT0, ypN0, ypM1(LYM), Grade 2, ypStage Ⅳ. The patient developed a post-operative anastomotic leakage that required drainage via laparotomy, but was discharged 76 days after surgery in good condition.
要旨 HER2陽性進行胃癌に対しcapecitabine+cisplatin+trastuzumab(XPT)療法を施行し臨床的完全奏効が得られ,R0切除を行い得た症例を経験したので報告する。症例は66歳,男性。胃角部大弯前壁に2型腫瘍を認め,生検でtub1-2,HER2: 3+。CTでは肝S1に21×9 mmの腫瘍を認め,3b,4d,16a2,16b1,左鎖骨上(Virchow)リンパ節は腫大していた。XPT療法を4コース施行したところ,臨床的完全奏効が得られた。以後capecitabine+trastuzumabのみ13コース継続し,手術を行った。幽門側胃切除D2郭清Billroth Ⅰ法再建,16a2,16b1,Virchowリンパ節摘出を行った。肝転移は認めなかった。摘出胃と領域リンパ節には病理組織学的悪性所見を認めなかったが,Virchowリンパ節に転移を認めた。病理所見はypT0,ypN0,ypM1(LYM),Grade 2,ypStage Ⅳであった。術後縫合不全を生じ開腹ドレナージを要したが,76日目に退院した。