title: Successful treatment of a patient with HER2-positive metastatic gastric cancer with third-line combination therapy with irinotecan, 5-fluorouracil, leucovorin and trastuzumab (FOLFIRI-T).
abstract: BACKGROUND
  For patients with HER2-overexpressing gastric cancer, there is an improved prognosis with additional trastuzumab to chemotherapy with a platinum compound and a fluoropyrimidin in first-line therapy. Second-line combinations are currently evaluated in various studies.
  
  
  METHODS
  We report the case of a 43-year-old male patient who came to our hospital with recurrent metastatic gastric cancer after curative surgery 18 months before. His disease responded well to several therapeutic regimens. Firstline chemotherapy with a combination of epirubicin, oxaliplatin and capecitabine (EOX) and the following therapies -- peritonectomy, multivisceral resection, hyperthermic intraperitoneal chemotherapy (HIPEC), and secondline chemotherapy with oxaliplatin, 5-fluorouracil and leucovorin (FLO) - induced a complete remission. At the time of the subsequent progression, HER2 overexpression was detected. We administered the combination of irinotecan, 5-fluorouracil, leucovorin (FOLFIRI) and trastuzumab, which to our knowledge was used for the first time in a patient with metastatic gastric cancer in third-line therapy. This regimen again induced a complete remission of the disease, which has been sustained now for at least 8 months.
  
  
  CONCLUSIONS
  This is the first time in the literature that a combination of FOLFIRI and trastuzumab (FOLFIRIT) was used successfully in a patient with recurrent metastatic gastric cancer.
authors: Klinik für Innere Medizin, Hämatologie/Onkologie und Palliativmedizin, Evangelisches Krankenhaus Bielefeld, Germany. Florian.Weissinger@evkb.de
authors: Florian
authors: F
authors: Weissinger
authors: Marc
authors: M
authors: Reymond
authors: Klaus
authors: K
authors: Dumke
authors: Martin
authors: M
authors: Krüger
mesh_terms: D000008:Abdominal Neoplasms / Q000188:drug therapy / Q000235:genetics / Q000473:pathology / Q000556:secondary* / Q000601:surgery; D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D018450:Disease Progression; D005472:Fluorouracil / Q000008:administration & dosage; D005743:Gastrectomy; D015972:Gene Expression Regulation, Neoplastic / Q000187:drug effects / Q000235:genetics; D006801:Humans; D002955:Leucovorin / Q000008:administration & dosage; D008197:Lymph Node Excision; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000235:genetics* / Q000473:pathology; D009367:Neoplasm Staging; D010166:Palliative Care; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000235:genetics*; D012086:Reoperation; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000235:genetics* / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D000068878:Trastuzumab; D014463:Ultrasonography
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D002166:Camptothecin; D005472:Fluorouracil; D002955:Leucovorin; D018719:Erb-b2 Receptor Tyrosine Kinases; D000068878:Trastuzumab; C508053:ERBB2 protein, human