Surgical resection of advanced gastric cancer following trastuzumab/oxaliplatin/capecitabine combination therapy

Abstract

Late-stage gastric adenocarcinoma patients have a poor prognosis because of high recurrence rates. To improve long-term outcomes, perioperative chemotherapies are combined with surgery. Human epidermal growth factor receptor 2 (HER2) overexpression had been noted in gastric cancer; therefore, trastuzumab has been used occasionally in this setting. A 63-year-old male Chinese patient, who was diagnosed with adenocarcinoma in the gastric antrum, as well as lymph node metastases along the left gastric and hepatic artery, and left adrenal area, was admitted to our hospital. HER2 expression was positive, and cluster amplification was detected in a fluorescence in situ hybridization assay. The patient received three cycles of a neoadjuvant trastuzumab/oxaliplatin /capecitabine regimen. He subsequently underwent distal gastrectomy, D2+ lymphadenectomy, left adrenalectomy, cholecystectomy and Billroth II anastomosis. Treatment was continued with another five postoperative cycles of the same medication and trastuzumab application for 1 year. No recurrence has been observed 18 mo after the operation. Trastuzumab as perioperative and adjuvant medication, in combination with oxaliplatin and capecitabine for a HER2-overexpressing advanced gastric adenocarcinoma, led to recurrence-free survival of at least 18 mo after surgery.

Keywords: Capecitabine; Gastric adenocarcinoma; Neoadjuvant medication; Oxaliplatin; Trastuzumab.

Figure 1

Fluorescence in situ hybridization analysis showing positive human epidermal growth factor receptor 2 expression with cluster amplification (ratio > 2.2).

Figure 2

Radiological evaluation by computed tomography scan before (A) and after three cycles (B) of neoadjuvant therapy of trastuzumab combined with oxaliplatin and capecitabine. The thickness of the stomach wall and the size of the lymph nodes had decreased dramatically.