内容紹介
A Case of HER-2 Positive Advanced Gastric Cancer Responding to Capecitabine+Cisplatin+Trastuzumab Chemotherapy
Summary
A 67-year-old woman was referred to our hospital for type 1 gastric cancer. We diagnosed the patient with advanced gastric cancer(tub2>por, HER2-positive), and the clinical findings were T4aN1M1(lung), Stage Ⅳ. The patient had cancer cachexia. As first-line chemotherapy, a regimen consisting of capecitabine(X)(1,600 mg/m2/day, days 1-14), cisplatin(P)(60 mg/m2/day, day 1), and trastuzumab(H)(8 mg/kg/day>6 mg/kg/day, day 1)was administered every 3 weeks and repeated 6 times. After receiving 6 courses, the patient's general condition and cancer cachexia symptoms improved. The size of the primary lesion significantly decreased, and lung metastasis was not visible on a PET scan. Simultaneously, a new 0-Ⅱc tumor was detected in the cardia, and a biopsy revealed a malignant lymphoma. Total gastrectomy and D2 lymph node dissection without splenectomy were performed. The final diagnosis was T4aN0M0. After treatment, the tumor was histologically evaluated as Grade 1b, and the remnant cancer cells were found to be HER2-negative(loss of HER2). The patient has been alive for 5 months and is receiving adjuvant chemotherapy comprising capecitabine and trastuzumab. Following chemotherapy containing trastuzumab, the patient with cachexia who was diagnosed with unresectable HER2-positive advanced gastric cancer showed improvement in the cachexia symptoms and the disappearance of lung metastasis.
要旨
症例は67歳,女性。胃癌ML,Post,Less,Gre,type 1,100 mm,tub2>por,cT4aN1M1(lung),cStage Ⅳ,HER2陽性(IHC3+)と診断した。初診時PS 2,Alb 2.2 g/dL,CRP 6.18 mg/dL,Hb 10.9 g/dLと癌悪液質状態にあった。全身状態を考慮してcapecitabine(X),cisplatin(P)ともに1段階減量したXP+trastuzumab(H)を6コース施行した。CTCAE Grade 2以上の有害事象は認めなかった。6コース施行後,癌悪液質は改善した。画像評価で肺転移巣は著明に縮小し,PET検査で集積を認めないためpartial responseと判定し,臨床的にはviableな腫瘍遺残はないと判断した。同時に,胃噴門直下に30 mm大の新規0-Ⅱc病変の出現を認め,生検結果より悪性リンパ腫の診断となった。転移巣が著明に縮小していること,新規に胃悪性リンパ腫が出現したことより,conversion surgeryの方針とした。開腹胃全摘,脾温存D2郭清,Roux-Y再建術を施行した。術後病理診断では,ML,Post,yType 3,45×25 mm,tub2>por,ypT4a,ly0,v0,ypN0,ypStage ⅡBで,組織学的効果判定はGrade 1bであった。術後はX+Hによる化学療法を継続しており,術後7か月間無再発生存中である。
目次
Summary
A 67-year-old woman was referred to our hospital for type 1 gastric cancer. We diagnosed the patient with advanced gastric cancer(tub2>por, HER2-positive), and the clinical findings were T4aN1M1(lung), Stage Ⅳ. The patient had cancer cachexia. As first-line chemotherapy, a regimen consisting of capecitabine(X)(1,600 mg/m2/day, days 1-14), cisplatin(P)(60 mg/m2/day, day 1), and trastuzumab(H)(8 mg/kg/day>6 mg/kg/day, day 1)was administered every 3 weeks and repeated 6 times. After receiving 6 courses, the patient's general condition and cancer cachexia symptoms improved. The size of the primary lesion significantly decreased, and lung metastasis was not visible on a PET scan. Simultaneously, a new 0-Ⅱc tumor was detected in the cardia, and a biopsy revealed a malignant lymphoma. Total gastrectomy and D2 lymph node dissection without splenectomy were performed. The final diagnosis was T4aN0M0. After treatment, the tumor was histologically evaluated as Grade 1b, and the remnant cancer cells were found to be HER2-negative(loss of HER2). The patient has been alive for 5 months and is receiving adjuvant chemotherapy comprising capecitabine and trastuzumab. Following chemotherapy containing trastuzumab, the patient with cachexia who was diagnosed with unresectable HER2-positive advanced gastric cancer showed improvement in the cachexia symptoms and the disappearance of lung metastasis.
要旨
症例は67歳,女性。胃癌ML,Post,Less,Gre,type 1,100 mm,tub2>por,cT4aN1M1(lung),cStage Ⅳ,HER2陽性(IHC3+)と診断した。初診時PS 2,Alb 2.2 g/dL,CRP 6.18 mg/dL,Hb 10.9 g/dLと癌悪液質状態にあった。全身状態を考慮してcapecitabine(X),cisplatin(P)ともに1段階減量したXP+trastuzumab(H)を6コース施行した。CTCAE Grade 2以上の有害事象は認めなかった。6コース施行後,癌悪液質は改善した。画像評価で肺転移巣は著明に縮小し,PET検査で集積を認めないためpartial responseと判定し,臨床的にはviableな腫瘍遺残はないと判断した。同時に,胃噴門直下に30 mm大の新規0-Ⅱc病変の出現を認め,生検結果より悪性リンパ腫の診断となった。転移巣が著明に縮小していること,新規に胃悪性リンパ腫が出現したことより,conversion surgeryの方針とした。開腹胃全摘,脾温存D2郭清,Roux-Y再建術を施行した。術後病理診断では,ML,Post,yType 3,45×25 mm,tub2>por,ypT4a,ly0,v0,ypN0,ypStage ⅡBで,組織学的効果判定はGrade 1bであった。術後はX+Hによる化学療法を継続しており,術後7か月間無再発生存中である。