A 66-Year-Old Man With Gastric Carcinoma
Bassel El-Rayes, MD, reviews the case of a 66-year old man with gastric carcinoma and discusses the disease from diagnosis to unmet needs.
Case: A 66-Year Old Male With HER2+ Gastric Cancer
Initial presentation
- A 66-year-old man complains of a 4-month history of decreased appetite and diffuse abdominal pain
- PMH: DM, medically controlled; colonoscopy at age 55 was unremarkable; no personal or family history of cancer
- PE: bloating; abdominal pain on deep palpation; otherwise unremarkable
Clinical Workup
- Labs: Hb 9.5 g/dL, plt 104 x 109/L; other lab values WNL
- Endoscopy with biopsy: showed well differentiated papillary adenocarcinoma with invasion into the lamina propria
- EUS: irregular borders on extraluminal surfaces with hyperechogenic spots
- Abdominal/pelvic CT confirmed a 5.1 cm lesion with indistinct margins in the antrum of the stomach
- Stage IV gastric adenocarcinoma; ECOG 1
- IHC score for HER2 expression 3+
- Biomarker testing: PD-L1 0%, NTRK -
- MSI by PCR/MMR by IHC: stable
Treatment
- He was started on FOLFOX + trastuzumab
- Well tolerated for 5 cycles
- Imaging showed 3 new small pulmonary lesions
- Treatment changed to docetaxel + ramucirumab
- Treatment was well tolerated for 4 cycles when he developed neutropenia
- Patient was started on trastuzumab deruxtecan; repeat HER2 expression score was not indicated
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