Department of Medical Oncology, Changzheng Hospital, Shanghai, China.
School of Laboratory Medicine and Life Science, Wenzhou Medical University, Zhejiang, China.
BMC Cancer. 2018 Feb 20;18(1):206. doi: 10.1186/s12885-018-4116-0.
Gastric cancer patients with widespread metastasis, especially meningeal metastases, have an extremely prognosis and limited therapeutic choices.
We reported the case of a 39-year-old male patient with HER2-positive gastric cancer with bone and meningeal metastases. He presented with multiple bone metastases and received 3 cycles of docetaxel plus S1. However, he complained with headache and imaging examinations revealed leptomeningeal carcinomatosis. FISH revealed that tumor cells in the cerebrospinal fluid were HER-positive. Herceptin was added to the regimen, but the symptoms were not relieved, the patient suffered from dizziness and nausea. The chemotherapy regimen was switched d to lapatinib (orally at 1250 mg/day, every day), capecitabine (orally at 1000 mg/m2, bid for 2 weeks, followed by a 1-week rest interval, as 1 cycle) and Herceptin (390 mg/3 weeks). After 3 weeks of the new treatment, all the symptoms relieved. The clinical complete response was maintained for 3 months.
Lapatinib/Capecitabine combination therapy is an alternative treatment strategy for leptomeningeal carcinomatosis of HER2-positive gastric cancer in which trastuzumab and/or chemotherapy essentially has no effect.
广泛转移，特别是脑膜转移的胃癌患者预后极差，治疗选择有限。
我们报告了一例 HER2 阳性胃癌伴骨和脑膜转移的 39 岁男性患者。他患有多处骨转移，接受了 3 个周期的多西紫杉醇加 S1 治疗。然而，他出现头痛，影像学检查显示脑膜转移。荧光原位杂交显示脑脊液中的肿瘤细胞 HER 阳性。加入赫赛汀治疗方案，但症状未缓解，患者出现头晕和恶心。化疗方案改为拉帕替尼（口服，每天 1250mg）、卡培他滨（口服，每天 1000mg/m2，2 周 1 次，1 周休息期，为 1 个周期）和赫赛汀（每 3 周 390mg）。新治疗 3 周后，所有症状均缓解。临床完全缓解持续了 3 个月。
对于曲妥珠单抗和/或化疗基本无效的 HER2 阳性胃癌脑膜转移，拉帕替尼/卡培他滨联合治疗是一种替代治疗策略。
