内容紹介
Summary
A man in his 60s with a large Type 3 gastric cancer presented with the chief complaint of epicardial discomfort. We decided to perform laparoscopy. The patient was diagnosed with cT4aN2M1(CY1), cStage Ⅳ disease and was treated with XP(capecitabine plus cisplatin[CDDP])plus trastuzumab(HER). After chemotherapy, CY0 was confirmed using laparoscopy. The patient underwent total gastrectomy and D2 lymph node dissection. Histopathological examination revealed ypT4aN3M0, ypStage ⅢC disease. Therefore, adjuvant treatment with XP plus HER was continued. Four months after surgery, liver, lung, and # 16b1latLN metastases were observed on CT. The metastatic foci were observed even after 3 courses of ramucirumab plus paclitaxel. Nivolumab was administered as the third-line treatment; after 3 courses, the liver metastasis increased markedly. Hence, our final diagnosis was hyperprogressive disease(HPD).
要旨
症例は60歳台,男性。心窩部不快感を主訴に,上部消化管内視鏡検査を施行し胃体中部に大型3型胃癌を認めた。CT検査で少量の腹水を認めたため,審査腹腔鏡検査を行う方針とした。洗浄腹水細胞診が陽性であり,cT4aN2M1(CY1),cStage Ⅳと診断し,HER2陽性でありcapecitabine+cisplatin(CDDP)+trastuzumab(XP+HER)を施行した。3コース施行後の審査腹腔鏡にてCY0を確認できたため,開腹胃全摘術,D2リンパ節郭清術を施行した。病理組織学的検査はypT4aN3M0,ypStage ⅢCであり,術後補助化学療法として進行・再発胃癌に準じてXP+HERを継続した。術後4か月目のCT検査にて肝転移,肺転移,#16b1latリンパ節再発を認めたため,ramucirumab+paclitaxelを3コース施行するも転移巣の増大を認めた。三次治療としてnivolumabを開始し,3コース施行後のCT検査では肝転移が著明に増大・増加し腹膜播種,腹水も出現し,CA19-9も著増し,PS 3へと低下したためhyperprogressive disease(HPD)と判断した。
目次
A man in his 60s with a large Type 3 gastric cancer presented with the chief complaint of epicardial discomfort. We decided to perform laparoscopy. The patient was diagnosed with cT4aN2M1(CY1), cStage Ⅳ disease and was treated with XP(capecitabine plus cisplatin[CDDP])plus trastuzumab(HER). After chemotherapy, CY0 was confirmed using laparoscopy. The patient underwent total gastrectomy and D2 lymph node dissection. Histopathological examination revealed ypT4aN3M0, ypStage ⅢC disease. Therefore, adjuvant treatment with XP plus HER was continued. Four months after surgery, liver, lung, and # 16b1latLN metastases were observed on CT. The metastatic foci were observed even after 3 courses of ramucirumab plus paclitaxel. Nivolumab was administered as the third-line treatment; after 3 courses, the liver metastasis increased markedly. Hence, our final diagnosis was hyperprogressive disease(HPD).
要旨
症例は60歳台,男性。心窩部不快感を主訴に,上部消化管内視鏡検査を施行し胃体中部に大型3型胃癌を認めた。CT検査で少量の腹水を認めたため,審査腹腔鏡検査を行う方針とした。洗浄腹水細胞診が陽性であり,cT4aN2M1(CY1),cStage Ⅳと診断し,HER2陽性でありcapecitabine+cisplatin(CDDP)+trastuzumab(XP+HER)を施行した。3コース施行後の審査腹腔鏡にてCY0を確認できたため,開腹胃全摘術,D2リンパ節郭清術を施行した。病理組織学的検査はypT4aN3M0,ypStage ⅢCであり,術後補助化学療法として進行・再発胃癌に準じてXP+HERを継続した。術後4か月目のCT検査にて肝転移,肺転移,#16b1latリンパ節再発を認めたため,ramucirumab+paclitaxelを3コース施行するも転移巣の増大を認めた。三次治療としてnivolumabを開始し,3コース施行後のCT検査では肝転移が著明に増大・増加し腹膜播種,腹水も出現し,CA19-9も著増し,PS 3へと低下したためhyperprogressive disease(HPD)と判断した。