Impressive Cases of Advanced Gastric Cancer Successfully Managed with Trastuzumab Containing Chemotherapy

ABSTRACT As a result of the ToGA trial, trastuzumab in combination with capecitabine–cisplatin (XP) chemotherapy is now considered a new standard option for patients with HER2-positive advanced gastric cancer. We report three cases that showed marked tumor shrinkage with the induction of XP–trastuzumab chemotherapy in a practical setting. Case 1: A 68-year-old man with gastric papillary adenocarcinoma (HER2 status IHC 3 + , FISH positive) and huge liver metastases producing a- phetoprotein, received four cycles of XP–trastuzumab therapy. Tumor response was PR and the toxicity (G3 neutropenia) was manageable. Case 2: A 65-year-old man with advanced gastric adenocarcinoma (IHC 3 + , FISH positive) had not only numerous liver metastases, but a liver abscess with a diameter of 5 cm. He initially received two cycles of s-1–trastuzumab concurrently with the systemic administration of antibiotics. Then followed by two cycles of XP–trastuzumab, metastatic liver lesions almost disappeared. There was no adverse event. Case 3: A 68-year-old man with gastric mucinous adenocarcinoma (IHC 2 + , FISH negative), turned out to be inoperable because of tumor invasion to the pancreas. Although seven cycles of XP–trastuzumab cause febrile neutropenia and severe hand-hoot syndrome, CT and endoscopy revealed a good treatment effect and suggested the potential for resection.