Prolonged Course of Metastatic Stomach Cancer with Long-term Stabilization – Case Report
In the following case report, we present the case of a patient with a prolonged oncological disease – stomach cancer. The patient has been asymptomatic for a long time and in good performance status despite multiple lung metastases, thanks to stabilization with trifluridine/tipiracil treatment.
A 65-year-old patient with a history of abdominal pain was examined at FN Motol (11/2017). A tumor of the gastroesophageal junction was detected, histologically an adenocarcinoma, and staging examinations ruled out generalization. It was evaluated as cT4N1M0 (by CT), and T3 by EUS.
In his history, ischemic heart disease (IHD) with the introduction of coronary stents in 2016, otherwise previously monitored for gastroesophageal reflux.
Indicated for perioperative chemotherapy and referred to us at the Oncology Clinic of the 3rd Faculty of Medicine of Charles University and FN Královské Vinohrady. Central venous port inserted and treatment started with the FLOT regimen (5-fluorouracil, oxaliplatin, docetaxel) supported by growth factors (1/2018). After 4 cycles, restaging was performed with significant regression according to CT (2/2018).
On April 10, 2018, at FN Motol, resection of the R1 distal esophagus, thoracic esophagogastroanastomosis was performed. Histologically adenocarcinoma G2 with infiltration into the adipose tissue of the resection base and into the adventitia in the gastroesophageal junction area, where it reaches the resection line, TRG 4 according to Mandard, 13 LU without metastases, ypT3ypN0 G2.
The patient underwent postoperative chemotherapy with the FLOT regimen for 4 cycles (from 5/2018). Due to R1 positivity, postoperative radiotherapy was performed 45 Gy to the area after esophageal resection (8–9/2018). He was followed up.
According to CT the following year, a suspected lung finding (1/2019), during the next check, the sites were stationary, only small (5 mm), without size progression (4/2019). In the following control CT, the condition was assessed as progression – for example, 1 of the lung sites clearly increased from 0.5 to 1 cm (8/2019). Systemic treatment was offered to the patient, which he refused at that time.
According to the next control CT, the lung finding without development (10/2019). The following year, based on control CTs (including PET/CT), a clear progression of the lung finding was noted (1/2020 and 5/2020). Systemic treatment was again offered, which he started with the combination of paclitaxel/ramucirumab (5/2020).
After 3 cycles, regression of lung metastases was evident on the next CT (8/2020), continued with another 3 cycles, where the control CT finding was assessed as stable (11/2020). Due to chemotherapy intolerance, the patient was subsequently treated with ramucirumab monotherapy every 14 days. According to the restaging CT (2/2021), the condition was assessed as progression (PD) according to RECIST criteria.
Change of treatment to trifluridine/tipiracil was indicated. An application for reimbursement from the health insurance according to §16 was submitted and after approval, its administration began (from 3/2021). The finding on the restaging CT (6/2021) was assessed as stable (SD), as well as during the next examination (1/2022). The patient continued the treatment with minimal dose reduction without significant difficulties. Throughout the therapy, the performance status (PS) according to WHO was practically 0–1.
MUDr. Markéta Šejdová
Oncology Clinic, 3rd Faculty of Medicine, Charles University and FNKV
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