Kimura Akitoshi, Kagiya Takuji, Yamauchi Youichi, Okano Kensuke, Sawano Takeyuki, Ohashi Motonari, Kato Masashi, Hashimoto Naoki, Umehara Yutaka, Nishikawa Shinsuke, Murata Akihiko, Takahashi Kenichi
Division of Gastroenterological Surgery, Clinical Oncology Center, Aomori Prefectural Central Hospital.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2027-2029.
We report a case in which recurrent partial HER2-positive gastric cancer showed complete clinical response to capecitabine (Cape)/oxaliplatin(L-OHP/OX)(CapeOX)plus trastuzumab(Tmab)combined chemotherapy for 32months. A 65-yearold man underwent distal gastrectomy, D2 lymph node dissection, and Roux-en-Y reconstruction for type 2 gastric cancer of the prepyloric anterior wall in December 2014. Pathological stage was as follows: L, ant, Type 2, 32×22 mm, tub1>tub2> por1, pT2(MP), int>med, INF c>a, Ly1a, V0, pN0, cM0, cH0, cP0, pCY0, pStage I B, pPM0(60mm), pDM0(75mm), pR0. Immunostaining of the tumor indicated overexpression of the HER2 gene in more than 10% of the well differentiated tubular adenocarcinoma(tub1). Nineteen months post-surgery, pancreatic head lymph node metastasis was diagnosed, and we started CapeOX plus Tmab combined chemotherapy. After 19 courses, the metastatic lymph node reduced its size until we could not detect it on CT. We continued treatment for 45 courses(about 32 months). During the courses, there were adverse events such as peripheral neuropathy(Grade 3, CTCAE v5.0), which required interruption of L-OHP, and oral mucosal ulcer (Grade 2).
我们报告了一例复发性部分HER2阳性胃癌患者，其对卡培他滨（Cape）/奥沙利铂（L-OHP/OX）（CapeOX）联合曲妥珠单抗（Tmab）的化疗方案表现出32个月的完全临床缓解。一名65岁男性于2014年12月因幽门前壁2型胃癌接受了远端胃切除术、D2淋巴结清扫术及Roux-en-Y重建术。病理分期如下：L，前壁，2型，32×22 mm，tub1>tub2>por1，pT2（MP），中分化>低分化，INF c>a，Ly1a，V0，pN0，cM0，cH0，cP0，pCY0，pStage I B，pPM0（60mm），pDM0（75mm），pR0。肿瘤免疫组化显示HER2基因在超过10%的高分化管状腺癌（tub1）中过表达。术后19个月，诊断为胰头淋巴结转移，我们开始使用CapeOX联合Tmab进行化疗。经过19个疗程后，转移淋巴结缩小，直至在CT上无法检测到。我们继续治疗了45个疗程（约32个月）。在疗程中，出现了外周神经病变（3级，CTCAE v5.0）等不良事件，这需要中断L-OHP治疗，以及口腔黏膜溃疡（2级）。
