[A case of unresectable advanced gastric cancer successfully treated with continuous S-1 + CPT-11 chemotherapy accompanied by dose reduction against grade 4 hematological adverse event].

We report a successful case of chemotherapy accompanied with grade 4 adverse events for unresectable advanced gastric cancer. A 73-year-old man was admitted to our hospital with complaint of abdominal pain in July 2007. The detailed examination had revealed advanced gastric cancer, lymph node metastasis, and multiple hepatic metastases. Performance status (PS) was level 0, and oral intake of medications was possible. Combined therapy with S-1 and CPT-11 (IRIS regimen) was performed from August as the first-line therapy. As a consequence of first course, grade 4 hematological adverse events (AEs) appeared and an urgent hospitalization was required. With whole body supportive care against grade 3 non-hematological AEs, which were diarrhea, anorexia, and fatigue, G-CSF, the broad-spectrum antibiotic were administered at the clean-room. After 1 course, cyto-reductive change was confirmed at the primary lesion and hepatic metastases. We continued the same regimen with dose reduction (S-1: 2 level dose down, CPT-11: 10% dose down). Although the regression of hepatic metastases was seen, we repeated the dose reduction of CPT-11 and the dose down level was reached to 40% for prolonged grade 2 neutropenia. After 6th courses, complete responses at primary lesion, lymph node, and hepatic metastases were achieved. The patient has received the same regimen of 9th course continuously as an outpatient, and CR has been maintained.