Patient Profile: A 60-Year-Old Man with Stage IV Gastric Adenocarcinoma

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EP: 1.Patient Profile: A 60-Year-Old Man with Stage IV Gastric Adenocarcinoma

EP: 2.Frontline Treatment Options for Gastric Adenocarcinoma

EP: 3.The Role of Immunotherapies in Upper GI Cancers

EP: 4.Managing Adverse Events from Immunotherapy in Upper Gastric Cancer

EP: 5.Second-Line Treatment of Gastric Adenocarcinoma

EP: 6.Ongoing Research in Upper Gastric Cancer

EP: 7.The Future of Upper Gastric Cancer Treatment

Case: A 60-Year-Old Man with Stage IV Gastric Adenocarcinoma

Clinical Presentation:

• A 60-year-old man with abrupt 10-pound weight loss, dyspepsia, bloating after meals, and loss of appetite, and all symptoms worsening over the past three months.
• PMH and FHx: Overweight and HTN. Patients father deceased at age 50 due to gastric cancer.

Initial Clinical Workup and Diagnosis:

• EGD showed 2 cm protruding mass in the body of the stomach
  • No Ulcerations
  • Biopsy showed poorly differentiated adenocarcinoma
• Stage IV adenocarcinoma
• Molecular Testing: HER2/neu –; MMRp/MSS, PD-L1 CPS 5%
• CT of abdomen and chest reveal a gastric polypoid mass and thickening; No ascites; 2 lesions in the left lower lobe.
• Lung Biopsy: metastatic adenocarcinoma consistent with gastric primary
• PET/CT confirmed metastatic disease

Current Treatments:

• Patient was initiated on FOLFOX +nivolumab

This is a video synopsis/summary of a Case-Based Peer Perspectives series featuring David Zhen, MD.

Zhen presents a case of a 60-year-old man with stage VI gastric adenocarcinoma. The patient experienced a 10-lb weight loss, dyspepsia, bloating after meals, and loss of appetite over the past 3 months. His medical history includes being overweight and having hypertension, and his father died of gastric cancer at age 50. Esophagogastroduodenoscopy revealed a 2-cm protruding mass in the stomach body, and biopsy confirmed poorly differentiated adenocarcinoma. CT and PET scans showed metastatic disease, including lung lesions. Molecular testing indicated the tumor was HER2/neu negative, mismatch repair proficient, and microsatellite stable. The patient was initiated on treatment with leucovorin, fluorouracil, oxaliplatin, and nivolumab. Zhen emphasizes the importance of maintaining patient nutrition, conducting molecular testing, and referring the patient to medical genetics due to the family history of gastric cancer. The treatment decision is based on the CheckMate649 trial, which demonstrated a survival benefit with the addition of nivolumab to standard chemotherapy in patients with a PD-L1 CPS equal to or greater than 5%.

Video synopsis is AI-generated and reviewed by Targeted Oncology™ editorial staff.