Suto Hirotaka, Inui Yumiko, Okamura Atsuo
Department of Medical Oncology, Hyogo Cancer Center, Hyogo, Japan.
Department of Medical Oncology/Hematology, Kakogawa Central City Hospital, Hyogo, Japan.
Front Oncol. 2024 Aug 6;14:1449212. doi: 10.3389/fonc.2024.1449212. eCollection 2024.
Bone marrow metastasis (BMM) of gastric cancer (GC), which is the most common cause of disseminated intravascular coagulation (DIC) among solid tumors, has a poor prognosis. Studies on prognostic improvement beyond one year in patients with GC with BMM are limited. This is the first report of a patient who survived over three years after 30 months of S-1 plus oxaliplatin (SOX) therapy for GC with BMM.
The patient was a 72-year-old woman who presented with anemia and high levels of alkaline phosphatase (ALP) and carbohydrate antigen 19-9 (CA19-9). Detailed examination led to the diagnosis with BMM of GC uncomplicated by DIC and the SOX regimen was initiated in November 2018. After six cycles, she was switched to S-1 monotherapy, and both ALP and CA19-9 levels reached normal by November 2019. However, computed tomography in April 2021 showed multiple bone metastases. Therefore, she was switched to paclitaxel-based therapy. In November 2021, the patient was further switched to nivolumab monotherapy, but she succumbed due to DIC in March 2022.
GCs with BMM are prone to DIC, and the SOX regimen, which includes S-1 with efficacy against micrometastases, may constitute a safe and effective treatment modality.
胃癌的骨髓转移（BMM）是实体瘤中弥散性血管内凝血（DIC）最常见的原因，预后较差。关于胃癌伴骨髓转移患者超过一年的预后改善研究有限。本文首次报道了一名胃癌伴骨髓转移患者在接受30个月的S-1联合奥沙利铂（SOX）治疗后存活超过三年的病例。
该患者为一名72岁女性，表现为贫血、碱性磷酸酶（ALP）和糖类抗原19-9（CA19-9）水平升高。详细检查后诊断为胃癌伴骨髓转移，未并发弥散性血管内凝血，并于2018年11月开始采用SOX方案治疗。六个周期后，改为S-1单药治疗，至2019年11月，ALP和CA19-9水平均恢复正常。然而，2021年4月的计算机断层扫描显示多处骨转移。因此，改为以紫杉醇为基础的治疗方案。2021年11月，患者进一步改为纳武单抗单药治疗，但于2022年3月因弥散性血管内凝血死亡。
胃癌伴骨髓转移易发生弥散性血管内凝血，包括对微转移有效的S-1的SOX方案可能是一种安全有效的治疗方式。
