内容紹介
HER2-Positive Advanced Gastric Cancer with Disseminated Intravascular Coagulation and Diffuse Bone Marrow Carcinomatosis Successfully Treated with S-1/Trastuzumab Chemotherapy―A Case Report
Summary
Trastuzumab, a humanized monoclonal antibody against human epidermal growth factor receptor 2(HER2), has been proven to result in a survival benefit for the treatment of patients with HER2-positive advanced gastric cancer(AGC). However, data are lacking for the treatment of those with disseminated intravascular coagulation(DIC)and diffuse bone marrow carcinomatosis. A 77-year-old woman presented with back pain and fatigue since 2 months. Esophagogastroduodenoscopy showed a scirrhous lesion in the gastric corpus, which was biopsied and identified as signet-ring cell carcinoma with HER2 overexpression on immunohistochemistry. Laboratory testing, bone scintigraphy, and bone marrow biopsy were conducted, and she was diagnosed with HER2-positive AGC with DIC and diffuse bone marrow carcinomatosis. She underwent chemotherapy with the following regimen: oral administration of 80 mg/m2 S-1 for 2 weeks and 6 mg/kg trastuzumab infusion on day 6 every 3 weeks, which significantly improved the DIC. She was discharged from the hospital 73 days after admission and survived for 438 days after diagnosis. To the best of our knowledge, this is the first case report in which HER2-positive AGC complicated by DIC with diffuse bone marrow carcinomatosis was successfully treated with combined chemotherapy consisting of S-1 plus trastuzumab.
要旨
症例は77歳,女性。背部痛を主訴に当科を受診した。上部消化管内視鏡検査で胃体部に4型病変を認め,生検で低分化型腺癌と診断された。human epidermal growth factor receptor 2(HER2)は陽性であった。骨シンチグラフィでは全身に多発性骨転移を示し,骨髄生検では腺癌細胞を多数認めた。また,血液検査ではdisseminated intravascular coagulation(DIC)が示唆された。以上より,胃癌骨髄癌腫症と診断した。血球減少が著しく進行したため,輸血・抗凝固療法を併用しながら,救命のために化学療法を開始した。S-1 80 mg/m2を14日間内服・7日間休薬,trastuzumab 6 mg/kg(初回のみ8 mg/kg)を3週に1回投与するS-1/trastuzumab併用療法を行ったところ,1コース終了の時点でDICを離脱でき,その後,約14か月の生存期間が得られた。この経験から,S-1/trastuzumab併用療法はHER2陽性胃癌骨髄癌腫症に対する有効な治療選択肢の一つと考えられた。
目次
Summary
Trastuzumab, a humanized monoclonal antibody against human epidermal growth factor receptor 2(HER2), has been proven to result in a survival benefit for the treatment of patients with HER2-positive advanced gastric cancer(AGC). However, data are lacking for the treatment of those with disseminated intravascular coagulation(DIC)and diffuse bone marrow carcinomatosis. A 77-year-old woman presented with back pain and fatigue since 2 months. Esophagogastroduodenoscopy showed a scirrhous lesion in the gastric corpus, which was biopsied and identified as signet-ring cell carcinoma with HER2 overexpression on immunohistochemistry. Laboratory testing, bone scintigraphy, and bone marrow biopsy were conducted, and she was diagnosed with HER2-positive AGC with DIC and diffuse bone marrow carcinomatosis. She underwent chemotherapy with the following regimen: oral administration of 80 mg/m2 S-1 for 2 weeks and 6 mg/kg trastuzumab infusion on day 6 every 3 weeks, which significantly improved the DIC. She was discharged from the hospital 73 days after admission and survived for 438 days after diagnosis. To the best of our knowledge, this is the first case report in which HER2-positive AGC complicated by DIC with diffuse bone marrow carcinomatosis was successfully treated with combined chemotherapy consisting of S-1 plus trastuzumab.
要旨
症例は77歳,女性。背部痛を主訴に当科を受診した。上部消化管内視鏡検査で胃体部に4型病変を認め,生検で低分化型腺癌と診断された。human epidermal growth factor receptor 2(HER2)は陽性であった。骨シンチグラフィでは全身に多発性骨転移を示し,骨髄生検では腺癌細胞を多数認めた。また,血液検査ではdisseminated intravascular coagulation(DIC)が示唆された。以上より,胃癌骨髄癌腫症と診断した。血球減少が著しく進行したため,輸血・抗凝固療法を併用しながら,救命のために化学療法を開始した。S-1 80 mg/m2を14日間内服・7日間休薬,trastuzumab 6 mg/kg(初回のみ8 mg/kg)を3週に1回投与するS-1/trastuzumab併用療法を行ったところ,1コース終了の時点でDICを離脱でき,その後,約14か月の生存期間が得られた。この経験から,S-1/trastuzumab併用療法はHER2陽性胃癌骨髄癌腫症に対する有効な治療選択肢の一つと考えられた。