Eguchi Satoshi, Akamaru Yusuke, Wada Noriko, Shimaoka Takahiro, Harada Soichiro, Ikeshima Ryo, Munakata Koji, Takiuchi Daisuke, Hama Naoki, Ota Hirofumi, Shibata Kunitaka
Dept. of Gastroenterological Surgery, Ikeda City Hospital.
Gan To Kagaku Ryoho. 2021 Dec;48(13):2045-2047.
A 65-year-old man with 1 month of general malaise was admitted to our hospital. Thoracoabdominal CT showed that the supra-clavicular, sub-carina, and para-aortic lymph nodes were swelling. Upper gastrointestinal endoscopy revealed 2 type 1 tumors at the esophagogastric junction, and the biopsy showed Group 5, well to moderately differentiated adenocarcinoma. The clinical diagnosis was cardiac gastric cancer and cStage Ⅳ(cT3N3M1[LYM]). We started capecitabine plus oxaliplatin as the first-line chemotherapy, and weekly paclitaxel plus ramucirumab was administered as the second-line treatment. The second-line treatment was successful, and the effect of PR was obtained. However, considering the period of TTF, while the therapeutic effect continued, we switched to third-line treatment with nivolumab after 7 courses of the second treatment. With the third-line treatment, PR was maintained for 1 year and 3 months, and good quality of life and performance status were obtained for a long period without irAE. However, after 32 courses, because the tumor marker was elevated and lymph nodes were enlarged, we judged PD and switched to the fourth-line treatment with nab-paclitaxel plus ramucirumab. The tumor marker levels decreased, the lymph nodes shrank, and PR was achieved again with the fourth-line treatment. The treatment is still ongoing 2 year and 8 months after the diagnosis.
一名65岁男性，全身不适1个月，入住我院。胸腹部CT显示锁骨上、隆突下和主动脉旁淋巴结肿大。上消化道内镜检查发现食管胃交界处有2处1型肿瘤，活检显示为5组，高分化至中分化腺癌。临床诊断为贲门胃癌，c期Ⅳ（cT3N3M1[LYM]）。我们开始使用卡培他滨加奥沙利铂作为一线化疗，二线治疗给予每周一次的紫杉醇加雷莫西尤单抗。二线治疗成功，获得了部分缓解（PR）的效果。然而，考虑到总缓解时间（TTF），在治疗效果持续的情况下，二线治疗7个疗程后，我们改用纳武单抗进行三线治疗。三线治疗时，PR维持了1年3个月，患者长期保持良好的生活质量和体能状态，且无免疫相关不良反应（irAE）。然而，32个疗程后，由于肿瘤标志物升高且淋巴结肿大，我们判断为疾病进展（PD），转而使用白蛋白结合型紫杉醇加雷莫西尤单抗进行四线治疗。四线治疗后肿瘤标志物水平下降，淋巴结缩小，再次获得了PR的效果。诊断后2年8个月，治疗仍在进行中。
