Therapeutic Approach for Stage 4 Gastric Cancer
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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