A Long-Term Survival Case of Advanced Alpha-Fetoprotein-Producing Gastric Cancer Successfully Treated with Multidisciplinary Therapy

Abstract

We report a long-term survival case following successful multidisciplinary treatment for advanced alpha-fetoprotein-producing gastric cancer. A 72-year-old female received S-1+oxaliplatin (SOX) therapy for advanced gastric cancer in the lesser curvature of the upper gastric body with liver metastasis in S6. After 3 courses of SOX, CT showed marked decreases of the gastric primary tumor and the liver metastasis. Total gastrectomy with D2 (-#10) lymph node dissection and metastasectomy in S6 of the liver were performed. The pathological findings were ypT3，ypN1，ypM1，ypStage IV. Adjuvant chemotherapy with 3 courses of SOX and 2 courses of S-1 was administered. Since CT revealed liver metastases in S4 and S7 at 1 year after the radical operation, nab-paclitaxel+ramucirumab (Nab-PTX+Rmab) therapy was initiated. After 4 courses of Nab-PTX+Rmab, CT showed marked shrinkage of both liver metastases. Radiofrequency ablation for the metastasis in S7 and metastasectomy in S4 of the liver were performed. S-1+docetaxel therapy (S-1+DOC) was administered as adjuvant chemotherapy. After 7 courses of S-1+DOC, FDG-PET CT showed increased accumulation of FDG in the hepatic portal lymph node, and a capecitabine+oxaliplatin (CapeOX) regimen was started. Accumulation of FDG in the hepatic portal lymph node disappeared after 3 courses of CapeOX; therefore, hepatic portal lymph node dissection was performed. CapeOX therapy was resumed after the operation. Since Grade 2 thrombocytopenia continued after 7 courses of CapeOX, this therapy was switched to capecitabine monotherapy. The patient is currently alive with no sign of recurrence for 4 years since the beginning of the multidisciplinary therapy.