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13
河 原 慎之輔，他
Abstract
A CASE OF HER-2-POSITIVE, STAGE IV, UNRESECTABLE,
ADVANCED GASTRIC CANCER TREATED BY CAPECITABINE,
CISPLATIN, AND TRASTUZUMAB CHEMOTHERAPY
WITH COMPLETE RESPONSE FOLLOWED BY CONVERSION SURGERY
Shinnosuke Kawahara 1 ）, Toru Aoyama 1 ）, Erika Muraoka 2 ）, Naoko Okuda 1 ）,
Yosuke Atsumi 1 ）, Keisuke Kazama 1 ）, Masakatsu Numata 1 ）, Hiroshi Tamagawa 1 ）,
Norio Yukawa 1 ）, Yasushi Rino 1 ）, Munetaka Masuda 1 ）
1）
2）
Department of Surgery, Yokohama City University
Department of Pathology, Yokohama City University Hospital
A 57-year-old male was referred to our department because gastric cancer was suspected on esophagogastro
duodenoscopy performed following abnormal screening. Type 2 gastric cancer (pap-tub1-tub2, HER2 score 3) was
found in the lesser curvature of the lower middle of the stomach. Abdominal enhanced computed tomography (CT)
and magnetic resonance imaging (MRI) showed bulky lymph node metastases and multiple liver metastases. He was
diagnosed with cT4aN2H1 (M1 HEP) P0CY0, cStageIV unresectable gastric cancer and was treated by chemotherapy
with XP plus trastuzumab (capecitabine [Xeloda] 1500 mg/m2 twice a day on days 1-14, CDDP 80 mg/m2 on day 1,
trastuzumab 8 mg/kg on day 1, every 3 weeks). CDDP was discontinued from the 3rd course due to renal insufficiency,
but after 6 courses of chemotherapy, the primary lesion, lymph node metastases, and liver metastases were not
visible on positron emission tomography-CT. Therefore, the patient was judged to have achieved a complete
response, diagnosed as ycT3 (SS) N0M0, ycStage IIA, and open distal gastrectomy, D2 lymphadenectomy, and
Roux-en-Y reconstruction were performed as conversion surgery. The chemotherapeutic effect was assessed as
Grade 3. He received 4 courses of X plus trastuzumab as adjuvant chemotherapy and is alive 2 years and 3 months
after surgery with no evidence of recurrence.
14
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