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Year : 2015  |  Volume : 11  |  Issue : 4  |  Page : 1026

A case of gastric cancer with liver metastases had a complete response with cisplatin and capecitabine as third-line chemotherapy

1 Department of Medical Oncology, 19 Mayis University Medical Faculty, Samsun, Turkey
2 Department of Nuclear Medicine, 19 Mayis University Medical Faculty, Samsun, Turkey

Date of Web Publication15-Feb-2016

Correspondence Address:
Fatih Teker
Department of Medical Oncology, 19 Mayis University Medical Faculty, Samsun
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0973-1482.150348

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 > Abstract 

Advanced gastric cancer has a poor prognosis, and only chemotherapy improves survival. Further chemotherapy after progression is controversial. Eastern Cooperative Oncology Group performance status is an important indicator for new chemotherapy decision. Complete response (CR) after recurrent disease is very rare, but could occur in some cases with chemotherapy. The 68-year-old male received chemotherapy for metastatic gastric adenocarcinoma. He received epirubicin, cisplatin and fluorouracil in the first line, capecitabine in the second line and cisplatin-capecitabine in the third line. CR was observed after third-line chemotherapy with four courses. Mediastinal and abdominal metastases were completely resolved. We decided to report this patient because it is very unusual to achieve CR in a patient in whom the best supportive care might be reasonable.

Keywords: Capecitabine, chemotherapy, cisplatin, gastric cancer, third line, treatment

How to cite this article:
Teker F, Canbaz F, Kemal Y, Yucel I. A case of gastric cancer with liver metastases had a complete response with cisplatin and capecitabine as third-line chemotherapy. J Can Res Ther 2015;11:1026

How to cite this URL:
Teker F, Canbaz F, Kemal Y, Yucel I. A case of gastric cancer with liver metastases had a complete response with cisplatin and capecitabine as third-line chemotherapy. J Can Res Ther [serial online] 2015 [cited 2020 Nov 25];11:1026. Available from: https://www.cancerjournal.net/text.asp?2015/11/4/1026/150348

 > Introduction Top

Advanced gastric cancer (AGC) has a poor prognosis, and palliative chemotherapy has been the only reasonable therapeutic option for patients with a median survival of 9–12 months. Among the agents with known antitumor activity, 5-fluorouracil and cisplatin (FP) have been extensively used in AGC. The results of the trials showed that capecitabine/cisplatin is an active and convenient alternative to FP. However, the complete response (CR) of advanced-stage gastric cancer to chemotherapy has been reported to be between 0% and 0.7%.[1] In this paper, we presented a case of metastatic gastric cancer that showed CR with cisplatin-capecitabine combination in the third line, despite poor prognostic factors and the advanced stage of the patient.

 > Case Report Top

A 68-year-old male underwent a curative subtotal gastrectomy and lymphadenectomy for gastric cancer in May 2011. No metastases were seen in computed tomography and staged as T2N0M0 gastric adenocarcinoma. There were no high-risk factors and according to available NCCN guideline; the patient was judged to follow up. After 5 months, multiple hepatic metastases were detected in magnetic resonance imaging (MRI), and biopsy was performed from liver. The histopathological result was reported as adenocarcinoma metastasis. Fluorescence in situ hybridization test resulted as negative. Subcutane port was implanted and epirubicin, cisplatin and fluorouracil (epirubicin: 50 mg/m 2 on D1, cisplatin: 60 mg/m 2 on D1, fluorouracil: 200 mg/m 2 on D1–21/21 days) chemotherapy was begun as first line in October 2011. After six courses of chemotherapy upon a regression at disease, two more courses were added and completed up to eight cycles. After 5 months, disease was progressed in September 2012 in MRI. Capecitabine monotherapy was administered as a second line for recurrence. However, disease progressed with worsening mediastinal and intra-abdominal lymph node metastases in May 2013, detected in flourine-18 fluorodeoxyglucose positron emission/computed tomography imaging [Figure 1]. The patient's performance status was well and we decided to try cisplatin again. Then the chemotherapy was changed to CDDP and capecitabine combination (cisplatin: 80 mg/m 2 on day 1, capecitabine: 2 × 1000 mg/m 2 1–14 days/21 days) in May 2013. After four courses of this treatment multiple mediastinal and intraabdominal pathological lymph nodes were completely resolved and a complete metabolic response (CR) was achieved in August 2013 [Figure 1].
Figure 1: Flourine-18 fluorodeoxyglucose positron emission/computed tomography (PET/CT) imaging: Multiple mediastinal and abdominal pathological hypermetabolic lymph nodes were seen before treatment. (a) Maximum intensity projection. Axial images of CT and fusion PET/CT showing inferior paratracheal and subaortic hypermetabolic lymph nodes (c) and interaortacaval and lateral aortic hypermetabolic lymph nodes (e). After four courses chemotherapy no metastatic hypermetabolic lesion could be detected in PET/CT imaging, indicating complete response to treatment (b, d and f)

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During the third-line chemotherapy, no adverse event of grade two or more did occur. Unfortunately, after 6 months, disease was progressed, and FOLFOX was administered as the fourth line. CR was achieved again after 12 courses of fourth-line chemotherapy. The patient is still alive for 9 months after the start of last chemotherapy.

 > Discussion Top

In western countries, about two-thirds of gastric cancer patients are diagnosed with locally advanced or metastatic disease. Poor performance status (PS > 2), liver metastasis, peritoneal metastases, advanced stage, and increased alkaline phosphatase levels are considered as unfavorable prognostic factors.[2] Our case had poor prognostic factors of multiple liver metastases.

After scanning the literature, in a study only 1 of 59 patients achieved CR to the FP chemotherapy in the first line.[3] In another retrospective analysis of 111 patients, no CR was observed after first line.[4] There are few large studies in the literature about the efficacy and tolerability of second line chemotherapy.[5] In the second line therapy study, CR was observed only 1 of 70 patient with FOLFIRI.[6] Little is known about the response rates of third line therapy. C-Met inhibitor was researched in a Phase-2 trial in second and third line, no CR was observed.[7] Another trial about the activity of docetaxel in the third line, there was no CR but only 5 of 33 patients were evaluated partial response.[8] The best response was a partial response in third line chemotherapy studies. Due to lack of the data, third line chemotherapy is not considered as standard therapy. There were only case reports about good responses in third or further line chemotherapies with different agents from Japan.[9] We decided to report this patient because it is very unusual to achieve CR in a patient in whom the best supportive care might be reasonable. Another interesting point of the patient, chemotherapy worked again in the four. Line setting with FOLFOX. According to our knowledge this was the first case showed CR in third line chemotherapy and near-CR in fourth line chemotherapy of gastric cancer with hepatic metastases. In our case there was a good response with first line chemotherapy. The response to the first-line treatment can be used to predict the effect of higher lines of treatment.[10] Some researchers suggested that poorly differentiated histology, elevated carcinoembryonic antigen and shorter time to progression of the first-line chemotherapy are the poor prognostic factors for second and third line chemotherapy. We need further studies to determine the chemosensitive subgroup of patients.

 > References Top

Koizumi W, Narahara H, Hara T, Takagane A, Akiya T, Takagi M, et al. S-1 plus cisplatin versus S-1 alone for first-line treatment of advanced gastric cancer (SPIRITS trial): A phase III trial. Lancet Oncol 2008;9:215-21.  Back to cited text no. 1
Chau I, Norman AR, Cunningham D, Waters JS, Oates J, Ross PJ. Multivariate prognostic factor analysis in locally advanced and metastatic esophago-gastric cancer – pooled analysis from three multicenter, randomized, controlled trials using individual patient data. J Clin Oncol 2004;22:2395-403.  Back to cited text no. 2
Koo DH, Ryu MH, Ryoo BY, Lee SS, Moon JH, Chang HM, et al. Three-week combination chemotherapy with S-1 and cisplatin as first-line treatment in patients with advanced gastric cancer: A retrospective study with 159 patients. Gastric Cancer 2012;15:305-12.  Back to cited text no. 3
Elsing C, Herrmann C, Hannig CV, Stremmel W, Jäger D, Herrmann T. Sequential chemotherapies for advanced gastric cancer: A retrospective analysis of 111 patients. Oncology 2013;85:262-8.  Back to cited text no. 4
Kim HS, Kim HJ, Kim SY, Kim TY, Lee KW, Baek SK, et al. Second-line chemotherapy versus supportive cancer treatment in advanced gastric cancer: A meta-analysis. Ann Oncol 2013;24:2850-4.  Back to cited text no. 5
Maugeri-Saccà M, Pizzuti L, Sergi D, Barba M, Belli F, Fattoruso S, et al. FOLFIRI as a second-line therapy in patients with docetaxel-pretreated gastric cancer: A historical cohort. J Exp Clin Cancer Res 2013;32:67.  Back to cited text no. 6
Kang YK, Muro K, Ryu MH, Yasui H, Nishina T, Ryoo BY, et al. A phase II trial of a selective c-Met inhibitor tivantinib (ARQ 197) monotherapy as a second-or third-line therapy in the patients with metastatic gastric cancer. Invest New Drugs 2014;32:355-61.  Back to cited text no. 7
Cho JY. Design of precise third-line therapy for gastric cancer: Target or chemotherpy? Korean J Intern Med 2013;28:297-9.  Back to cited text no. 8
Yagi Y, Ichikawa K, Takahashi K, Okuda N. A case of recurrent gastric cancer with peritoneal dissemination responding to doxifluridine/paclitaxel combination chemotherapy as third-line treatment. Gan To Kagaku Ryoho 2007;34:261-3.  Back to cited text no. 9
Kodera Y, Ito Y, Ohashi N, Nakayama G, Koike M, Fujiwara M, et al. Impact of clinical response to first-line chemotherapy on gastric cancer patients treated with second-line and third-line chemotherapy. Hepatogastroenterology 2011;58:1041-5.  Back to cited text no. 10


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