内容紹介
Summary
A 74-year-old man with upper abdominal pain and anorexia was referred to our hospital in December 2013. Based on computed tomography(CT)and gastroendoscopy findings, the patient was diagnosed as having advanced gastric cancer with multiple liver metastases(S3, S5, and S6 lesions). Because of high pyloric stenosis, distal gastrectomy Roux-en-Y reconstruction was performed in mid-December 2013. Histopathological findings of the patient were L, Ant-Gre, 35×60 mm, type 2, pT4a(SE), tub2>tub1, int, INF b, ly2, v1(VB), pPM0(95 mm), pDM0(15 mm), pN0(0/2), HER2(IHC 3+). Postoperatively, the patient received combined S-1/trastuzumab chemotherapy toward the end of January 2014. The clinical response was PR after 2 courses and clinical CR(cCR)after 4 courses. Because hand-foot syndrome caused by S-1 was prolonged, the dosage was completed in 11 courses. He remains alive 4.5 years after surgery without recurrence. Although ToGA examination showed that trastuzumab was effective for HER 2-positive unresectable gastric cancer, few reported cases showed progression to cCR after the treatment followed by a regimen of trastuzumab without CDDP, and they had good prognosis. Furthermore, in this case, the liver metastases showed complete response without CDDP. Thus, trastuzumab might be a chemotherapy option for patients who have difficulty using platinum analogs, including the elderly patients.
要旨
症例は74歳,男性。2013年12月,心窩部不快感・食思不振を主訴に当院を受診した。上部消化管内視鏡検査にて胃幽門部に2型腫瘍,同部位からの生検で中分化腺癌を検出した。腹部造影CT検査にて多発肝転移を認め,cT3N2M1,cStage Ⅳの診断であったが,高度の幽門狭窄を認め2013年12月中旬,幽門側胃切除術を施行した。術後病理組織学的検査にてHER2強陽性を認め,2014年1月下旬より肝転移巣に対してS-1+trastuzumabを開始したところ2コース後にPR,4コース後に臨床的CR(clinical CR: cCR)となった。S-1による手足症候群が遷延したため11コースで投与を終了した。以降は化学療法を施行せず経過観察しているが,術後4年6か月経過した現在,無再発生存中である。HER2陽性切除不能胃癌に対するtrastuzumabの有効性はToGA試験にて有意な延命効果が認められたが,trastuzumab投与後にcCRとなり予後良好であった報告例は少ない。今回の症例は貴重な1例であり,HER2陽性胃癌同時性肝転移に対してS-1+trastuzumabは有効な治療選択肢の一つと考えられた。
目次
A 74-year-old man with upper abdominal pain and anorexia was referred to our hospital in December 2013. Based on computed tomography(CT)and gastroendoscopy findings, the patient was diagnosed as having advanced gastric cancer with multiple liver metastases(S3, S5, and S6 lesions). Because of high pyloric stenosis, distal gastrectomy Roux-en-Y reconstruction was performed in mid-December 2013. Histopathological findings of the patient were L, Ant-Gre, 35×60 mm, type 2, pT4a(SE), tub2>tub1, int, INF b, ly2, v1(VB), pPM0(95 mm), pDM0(15 mm), pN0(0/2), HER2(IHC 3+). Postoperatively, the patient received combined S-1/trastuzumab chemotherapy toward the end of January 2014. The clinical response was PR after 2 courses and clinical CR(cCR)after 4 courses. Because hand-foot syndrome caused by S-1 was prolonged, the dosage was completed in 11 courses. He remains alive 4.5 years after surgery without recurrence. Although ToGA examination showed that trastuzumab was effective for HER 2-positive unresectable gastric cancer, few reported cases showed progression to cCR after the treatment followed by a regimen of trastuzumab without CDDP, and they had good prognosis. Furthermore, in this case, the liver metastases showed complete response without CDDP. Thus, trastuzumab might be a chemotherapy option for patients who have difficulty using platinum analogs, including the elderly patients.
要旨
症例は74歳,男性。2013年12月,心窩部不快感・食思不振を主訴に当院を受診した。上部消化管内視鏡検査にて胃幽門部に2型腫瘍,同部位からの生検で中分化腺癌を検出した。腹部造影CT検査にて多発肝転移を認め,cT3N2M1,cStage Ⅳの診断であったが,高度の幽門狭窄を認め2013年12月中旬,幽門側胃切除術を施行した。術後病理組織学的検査にてHER2強陽性を認め,2014年1月下旬より肝転移巣に対してS-1+trastuzumabを開始したところ2コース後にPR,4コース後に臨床的CR(clinical CR: cCR)となった。S-1による手足症候群が遷延したため11コースで投与を終了した。以降は化学療法を施行せず経過観察しているが,術後4年6か月経過した現在,無再発生存中である。HER2陽性切除不能胃癌に対するtrastuzumabの有効性はToGA試験にて有意な延命効果が認められたが,trastuzumab投与後にcCRとなり予後良好であった報告例は少ない。今回の症例は貴重な1例であり,HER2陽性胃癌同時性肝転移に対してS-1+trastuzumabは有効な治療選択肢の一つと考えられた。