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Gastrointestinal Cancer Case Studies

Case Studies: Therapeutic Approach for Stage 4 Gastric Cancer

In this case-based interview, Manish A. Shah, MD, discusses the case of a 54-year-old man who presents with stage 4 gastroesophageal junction cancer and the treatment approach for this type of patient.

Therapeutic Approach for Stage 4 Gastric Cancer

A 54-Year-Old Man With Stage IV Gastroesophageal Junction Cancer

January 2018

  • A 54-year-old man presented to his PCP complaining of loss of appetite, indigestion, and dysphagia lasting approximately 4 months and subsequent 12-lb weight loss
  • PE: patient was pale-appearing; abdominal auscultation
  • Notable laboratory findings:
    • HB 10.8 g/dL
    • LFT WNL
    • CEA, 18.4 ng/mL
  • Upper GI endoscopy with endoscopic ultrasound showed a hypoechoic mass, approximately 3.3 cm, located in the gastric cardia and extending to the gastroesophageal junction, infiltrating the gastric wall into the subserosal mucosa
  • Biopsy results confirmed poorly differentiated gastric adenocarcinoma
    • Molecular testing; HER2(-), MSI-stable, PD-L1 expression 0%
  • CT of chest, abdomen, and pelvis indicated liver mets confirmed
  • Staging; GEJ adenocarcinoma T4bN0M1, unresectable, Siewert II
  • PS; ECOG 0
  • After multidisciplinary assessment, the patient was started on FOLFOX
  • Three-month follow-up
    • Imaging showed a partial response to systemic therapy
    • Patient complained of mild neuropathy; oxaliplatin was discontinued after 4 cycles of chemotherapy

July 2018

  • Patient reports increasing fatigue
  • CT imaging at 6 months shows metastatic spread to multiple subcarinal and right hilar lymph nodes; increased size in two of the liver lesions
  • PS; ECOG 1
  • Patient is motivated to try another systemic therapy
  • The patient is planned to start therapy with paclitaxel/ramucirumab
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