Abstract
We report a 49-year-old Chinese male with locally advanced gastric adenocarcinoma achieving pathological complete response after neoadjuvant chemotherapy with trastuzumab-containing regimen. He underwent esophagogastroduodenoscopy in September 2009, which revealed a 2-cm gastric ulcer on the lesser curvature proximal to angularis. Biopsy of gastric ulcer showed moderately differentiated adenocarcinoma with overexpression of human epidermal growth factor receptor 2 (HER2) by immunohistochemistry and fluorescence in situ hybridization. Further workups with endoscopic ultrasound, computed tomography and positron emission tomography staged his cancer as T3N1M0. He received 3 cycles of neoadjuvant chemotherapy consisting of trastuzumab, oxaliplatin, docetaxel and capecitabine without severe toxicities except grade 2 diarrhea near the completion of cycle 3 requiring discontinuation of capecitabine. Afterwards, he received total gastrectomy with extended D2 lymph node dissections showing pathological complete response. He went on to receive 3 more cycles of chemotherapy postoperatively. The role of trastuzumab as a part of perioperative therapy in gastric cancer overexpressing HER2 is worth further investigation.
Highlights
Gastric cancer is the fourth most common cancer worldwide, with overall 5-year survival rate of approximate 20%, representing a significant challenge for the treating physicians [1]
We describe a case of pathological complete response after neoadjuvant chemotherapy with trastuzumab-containing regimen in gastric cancer
human epidermal growth factor receptor 2 (HER2) overexpression due to gene amplification in gastric cancer has led to aggressive clinical course and poor prognosis [8]
Summary
Gastric cancer is the fourth most common cancer worldwide, with overall 5-year survival rate of approximate 20%, representing a significant challenge for the treating physicians [1]. Response to neoadjuvant treatment is the most important predictor of survival after curative resection of gastric cancer [3,4,5] In this case report, we describe a case of pathological complete response after neoadjuvant chemotherapy with trastuzumab-containing regimen in gastric cancer. There were no tumor identified in 44 perigastric lymph nodes and 2 lymph nodes from porta hepatis He recovered uneventfully after surgery, and received 3 more cycles of chemotherapy with the same regimen with dose reduction on docetaxel and capecitabine due to gastrointestinal toxicities.
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