HER2-positive Gastric Cancer with Nodal Metastasis Successfully Resected After Chemo w/ Trastuzumab
- 3 years ago
Anticancer Research February 2014, 34 (2) 867-872;
https://ar.iiarjournals.org/content/34/2/867.long
In May 2011, a 49-year-old woman with epigastralgia underwent upper-gastrointestinal (GI) endoscopy, during which an irregular lesion at the posterior wall of the antrum was noted. In June 2011, she was referred to our hospital for further examination. The upper GI endoscopy showed a centrally-ulcerating tumor that was indistinctly delineated from its surroundings at the antrum. Stenosis of the pylorus was also evident. Examination of a biopsy specimen led to the diagnosis of a moderately-differentiated adenocarcinoma, and immunohistochemistry (IHC) showed a tumor cell cluster with strong complete basolateral membranous reactivity (Figure 1), the presence of which identified the case as IHC3+ according to the IHC scoring system that was used in the ToGA trial (1). Barium meal radiography showed a circumscribed crater with irregular borders and a surrounding radiolucent defect. Computed tomography (CT) showed two swollen paraaortic lymph nodes that were 17 mm and 14 mm in diameter (Figure 2). Coincidentally, the tumor was considered unresectable.
In June 2011, we first performed a stomach-partitioning gastrojejunostomy, because of the stenosis. There was no peritoneal metastasis. Further, cytological examination indicated that the peritoneal washings were negative for carcinoma. After palliative surgery, the patient received three courses of trastuzumab (as a molecular-targeted therapy), which were initiated in August 2011 in combination with chemotherapy with capecitabine and cisplatin. This combination was similar to the combination used in the ToGA trial (1). Capecitabine (1,000 mg/m2) was administered orally twice a day for 14 days, followed by a 1-week interval. An intravenous infusion of cisplatin (80 mg/m2) was given on day 1. Trastuzumab was administered by intravenous infusion at a dose of 8 mg/kg on day 1 of the first course, followed by 6 mg/kg every 3 weeks. This treatment resulted in a partial response. However, our patient experienced incremental nausea following cisplatin therapy and, despite the use of anti-emetic agents, she was unable to even drink water during the fourth course of chemotherapy. Subsequently, she was administered a combination of capecitabine and trastuzumab. During the therapy, she suffered from mild but tolerable weakness, and was able to continue treatment.
After completion of the 12th course of chemotherapy, the swollen paraaortic lymph nodes disappeared (Figure 3). This indicated that the patient was clinically cured; however, because of concerns regarding progression of the disease with time and age, we decided to perform a surgical resection of any residual tumor (after obtaining informed consent from the patient). We then successfully performed distal gastrectomy (D2) as curative surgery in November 2012. We found no peritoneal metastasis, and cytological examination of the peritoneal washings indicated
https://ar.iiarjournals.org/content/34/2/867.long
In May 2011, a 49-year-old woman with epigastralgia underwent upper-gastrointestinal (GI) endoscopy, during which an irregular lesion at the posterior wall of the antrum was noted. In June 2011, she was referred to our hospital for further examination. The upper GI endoscopy showed a centrally-ulcerating tumor that was indistinctly delineated from its surroundings at the antrum. Stenosis of the pylorus was also evident. Examination of a biopsy specimen led to the diagnosis of a moderately-differentiated adenocarcinoma, and immunohistochemistry (IHC) showed a tumor cell cluster with strong complete basolateral membranous reactivity (Figure 1), the presence of which identified the case as IHC3+ according to the IHC scoring system that was used in the ToGA trial (1). Barium meal radiography showed a circumscribed crater with irregular borders and a surrounding radiolucent defect. Computed tomography (CT) showed two swollen paraaortic lymph nodes that were 17 mm and 14 mm in diameter (Figure 2). Coincidentally, the tumor was considered unresectable.
In June 2011, we first performed a stomach-partitioning gastrojejunostomy, because of the stenosis. There was no peritoneal metastasis. Further, cytological examination indicated that the peritoneal washings were negative for carcinoma. After palliative surgery, the patient received three courses of trastuzumab (as a molecular-targeted therapy), which were initiated in August 2011 in combination with chemotherapy with capecitabine and cisplatin. This combination was similar to the combination used in the ToGA trial (1). Capecitabine (1,000 mg/m2) was administered orally twice a day for 14 days, followed by a 1-week interval. An intravenous infusion of cisplatin (80 mg/m2) was given on day 1. Trastuzumab was administered by intravenous infusion at a dose of 8 mg/kg on day 1 of the first course, followed by 6 mg/kg every 3 weeks. This treatment resulted in a partial response. However, our patient experienced incremental nausea following cisplatin therapy and, despite the use of anti-emetic agents, she was unable to even drink water during the fourth course of chemotherapy. Subsequently, she was administered a combination of capecitabine and trastuzumab. During the therapy, she suffered from mild but tolerable weakness, and was able to continue treatment.
After completion of the 12th course of chemotherapy, the swollen paraaortic lymph nodes disappeared (Figure 3). This indicated that the patient was clinically cured; however, because of concerns regarding progression of the disease with time and age, we decided to perform a surgical resection of any residual tumor (after obtaining informed consent from the patient). We then successfully performed distal gastrectomy (D2) as curative surgery in November 2012. We found no peritoneal metastasis, and cytological examination of the peritoneal washings indicated