背景:尽管晚期或复发性胃癌的治疗有了新的进展,中位生存时间仍短于15个月.在这里,我们报道了一例胃癌术后复发的病例,其中曲妥珠单抗deruxtecan作为6线治疗可获得完全临床缓解.
方法:一名70岁男子在直肠癌手术后随访期间接受了腹部对比增强计算机断层扫描(CT)。CT显示胃周淋巴结肿大。经过进一步检查,患者的病情被诊断为胃癌cT2N1H0P0M0cIIA期。患者接受了远端胃切除术和D2淋巴结清扫术。结果病理诊断为pT1bN3aH0P0pStageIIB,HER2评分3+。术后19个月腹部增强CT显示主动脉旁淋巴结复发,因此计划了全身化疗疗程.主要治疗是S-1,顺铂,曲妥珠单抗共11个疗程。然而,主动脉旁淋巴结肿大,被评估为进行性疾病.各种方案的系统化疗持续到5线治疗。然而,未实现治疗获益,并观察到肺转移.曲妥珠单抗deruxtecan(TDXD)开始作为6线治疗。治疗开始后4个月腹部增强CT显示主动脉旁淋巴结肿大明显缩小,右肺上叶转移灶消失,评估为部分反应(PR)。主动脉旁淋巴结转移被评估为PR,仅有轻微的SUV-Max2.66积累,并在1年后通过正电子发射断层扫描计算机断层扫描(PET-CT)进行缩小趋势。肿瘤标志物CEA,CA19-9和CA125也显著改善。1年4个月后PET-CT显示无淋巴结肿大或积聚,表示完整响应(CR)。所有肿瘤标记物也标准化。迄今为止,该患者在没有额外治疗的情况下保持了临床CR。
结论:我们报告了TDXD成功治疗的首例胃癌术后复发,以TDXD作为六线治疗实现临床CR。
BACKGROUND: Despite the recent developments in the treatment of advanced or recurrent gastric cancer, the median survival time remains shorter than 15 months. Herein, we report a
case of postoperative gastric cancer recurrence in which a complete clinical response was achieved with trastuzumab deruxtecan as 6th-line treatment.
METHODS: A 70-year-old man underwent abdominal contrast-enhanced computed tomography (CT) during follow-up after rectal cancer surgery. The CT revealed an enlarged perigastric lymph node. After further examination, the patient\'s condition was diagnosed as gastric cancer cT2N1H0P0M0 cStage IIA. The patient underwent distal gastrectomy and D2 lymph node dissection. The resulting pathological diagnosis was pT1bN3aH0P0 pStageIIB, HER2 score 3+. Abdominal contrast-enhanced CT 19 months postoperatively revealed para-aortic lymph node recurrence, thus systemic chemotherapy courses were planned. The primary treatment was a combination of S-1, cisplatin, and trastuzumab administered in 11 courses. However, there was an enlargement of the para-aortic lymph node which was evaluated as progressive disease. Systematic chemotherapy with various regimens was continued until the 5th-line treatment. However, therapeutic benefits were not achieved and lung metastasis was observed. Trastuzumab deruxtecan (TDXD) was initiated as 6th-line treatment. Abdominal contrast-enhanced CT at 4 months after the start of treatment showed marked shrinkage of the enlarged para-aortic lymph node and disappearance of the lung metastasis in the right upper lung lobe, which was evaluated as partial response (PR). The para-aortic lymph node metastasis was evaluated as PR with only a slight accumulation of SUV-Max 2.66 with a shrinking trend by positron emission tomography-computed tomography (PET-CT) performed after 1 year. Tumor markers CEA, CA19-9, and CA125 also improved significantly. PET-CT after 1 year and 4 months showed no lymph node enlargement or accumulation, indicating a complete response (CR). All tumor markers also normalized. The patient has maintained clinical CR without additional treatment to date.
CONCLUSIONS: We report the apparent first
case of postoperative gastric cancer recurrence successfully treated with TDXD, achieving clinical CR with TDXD as a 6th-line treatment.