Salvage Surgery for Unresectable Advanced Esophagogastric Junction Carcinoma with Multiple Liver Metastases after Successful Second-Line Treatment with Nab-Paclitaxel and Ramucirumab Following a Refractory Response to S-1 plus CDDP Therapy-A Case Report

• Published in: Gan to kagaku ryoho Vol. 47; no. 11; p. 1597
• Main Authors: Fujita, Takahisa, Shimizu, Yoshio, Dongping, Feng, Yamamoto, Naoki, Kobayashi, Mitsuyoshi, Iwabu, Hiroyuki, Tsuji, Akihito
• Format: Journal Article
• Language: Japanese
• Published: Japan 01-11-2020
• Subjects: Albumins; Antibodies, Monoclonal, Humanized; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Cisplatin - therapeutic use; Drug Combinations; Esophagogastric Junction - surgery; Gastrectomy; Humans; Liver Neoplasms - drug therapy; Liver Neoplasms - surgery; Male; Middle Aged; Oxonic Acid - therapeutic use; Paclitaxel; Positron Emission Tomography Computed Tomography; Ramucirumab; Stomach Neoplasms - drug therapy; Stomach Neoplasms - surgery; Tegafur - therapeutic use
• ISSN: 0385-0684

We report a case of unresectable advanced esophagogastric junction carcinoma that was treated with nab-paclitaxel and ramucirumab, which resulted in complete response and salvage surgery. A 57-year-old male complained of upper abdominal discomfort. While attending a hospital for diabetes mellitus, upper gastrointestinal endoscopy was performed. A tumor protruding from the gastric cardia to the abdominal esophagus was found, and histological examination revealed well-differentiated adenocarcinoma. Multiple liver metastases and para-aortic lymph node metastases were found on abdominal contrast-enhanced CT. The patient was diagnosed with stage Ⅳ cancer, and chemotherapy was performed as unresectable advanced esophagogastric junction carcinoma. S-1 plus CDDP therapy was started as the first-line treatment. After 2 courses of S-1 plus CDDP therapy, tumor markers were elevated. Further, the cancer was judged to be highly toxic and refractory to treatment; therefore, we started nab-paclitaxel and ramucirumab as the secondary treatment. After 4 courses, normalization of tumor markers, disappearance of liver metastases, and marked reduction of enlarged lymph nodes were observed. However, PET-CT showed increased uptake, consistent with the primary lesion. Residual cancer could not be ruled-out; therefore, total gastrectomy was performed. Histopathological examination of the surgically resected specimen showed no residual tumors.