Published online Sep 14, 2014. doi: 10.3748/wjg.v20.i34.12355
Revised: March 20, 2014
Accepted: May 12, 2014
Published online: September 14, 2014
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Late-stage gastric adenocarcinoma patients have a poor prognosis because of high recurrence rates. To improve long-term outcomes, perioperative chemotherapies are combined with surgery. Human epidermal growth factor receptor 2 (HER2) overexpression had been noted in gastric cancer; therefore, trastuzumab has been used occasionally in this setting. A 63-year-old male Chinese patient, who was diagnosed with adenocarcinoma in the gastric antrum, as well as lymph node metastases along the left gastric and hepatic artery, and left adrenal area, was admitted to our hospital. HER2 expression was positive, and cluster amplification was detected in a fluorescence in situ hybridization assay. The patient received three cycles of a neoadjuvant trastuzumab/oxaliplatin /capecitabine regimen. He subsequently underwent distal gastrectomy, D2+ lymphadenectomy, left adrenalectomy, cholecystectomy and Billroth II anastomosis. Treatment was continued with another five postoperative cycles of the same medication and trastuzumab application for 1 year. No recurrence has been observed 18 mo after the operation. Trastuzumab as perioperative and adjuvant medication, in combination with oxaliplatin and capecitabine for a HER2-overexpressing advanced gastric adenocarcinoma, led to recurrence-free survival of at least 18 mo after surgery.
Core tip: Surgical resection of advanced gastric cancer is accompanied by a high frequency of recurrences and metastases. To curb cancerous cell growth, cytostatic medications are commonly used; however, tumor cell-specific drugs are being researched increasingly. Human epidermal growth factor receptor 2 (HER2) has been recognized as a target for breast cancer medications, and the application of the monoclonal antibody trastuzumab led to remissions of HER2-positive breast cancers, which comprise about 30% of all cases. HER2 overexpression was also detected in gastric cancers; therefore, trastuzumab as an adjuvant or neoadjuvant therapy has been used as a new approach to treat these tumors.