title: Successful paclitaxel-based chemotherapy for an alpha-fetoprotein-producing gastric cancer patient with multiple liver metastases.
abstract: BACKGROUND
  Alpha-fetoprotein (AFP)-producing gastric cancer is known to frequently cause multiple liver metastases and to have an extremely poor prognosis.
  
  
  METHODS
  A 64-year-old Japanese man admitted to our hospital was diagnosed with gastric cancer with liver metastases. He underwent a total gastrectomy with splenectomy, and pathological stage IV disease according to the classification proposed by the Japanese Gastric Cancer Association was assigned. The histological diagnosis was poorly differentiated adenocarcinoma, and tumor production of AFP was confirmed by immunohistochemical staining. Following surgery, the patient received combination chemotherapy consisting of TS-1 and paclitaxel. Initially, AFP levels decreased dramatically and computed tomography (CT) revealed regression of liver metastases. However, multiple new liver metastases appeared and serum AFP levels increased after 5 months. A regimen of 5-FU plus paclitaxel followed by paclitaxel monotherapy was used next. Serum AFP levels once again decreased and CT showed regression or disappearance of liver metastases. The patient currently has a very good quality of life, and is receiving weekly paclitaxel monotherapy as an outpatient. No progression of liver metastases has been observed to date.
  
  
  CONCLUSIONS
  We consider this rare case to have significant value with respect to treatment of AFP-producing gastric cancer with multiple liver metastases, and propose that combining surgery with chemotherapeutic agents such as paclitaxel may lead to a better prognosis in such cases.
authors.affiliation: Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Kawasumi 1, Mizuho-cho, Mizuho-ku, Nagoya 4678601, Japan. takeyama@med.nagoya-cu.ac.jp
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Takeyama
authors.forename: Hirozumi
authors.initials: H
authors.lastname: Sawai
authors.forename: Takehiro
authors.initials: T
authors.lastname: Wakasugi
authors.forename: Hiroki
authors.initials: H
authors.lastname: Takahashi
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Matsuo
authors.forename: Nobuo
authors.initials: N
authors.lastname: Ochi
authors.forename: Akira
authors.initials: A
authors.lastname: Yasuda
authors.forename: Mikinori
authors.initials: M
authors.lastname: Sato
authors.forename: Yuji
authors.initials: Y
authors.lastname: Okada
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Funahashi
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Akamo
authors.forename: Tadao
authors.initials: T
authors.lastname: Manabe
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy* / Q000556:secondary; D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use*; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000627:therapeutic use*; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D000509:alpha-Fetoproteins / Q000096:biosynthesis*
chemical_list: D000972:Antineoplastic Agents, Phytogenic; D000509:alpha-Fetoproteins; D017239:Paclitaxel