title: A case of severe cerebral embolism after chemotherapy for HER2-positive gastric cancer.
abstract: BACKGROUND
  Trastuzumab + chemotherapy is considered the standard therapy for advanced human epidermal growth factor receptor 2 (HER2)-positive gastric cancer with mild manageable toxicity, on the basis of the results of a pivotal phase-III trial. Cerebrovascular events are not recognized as expected adverse effects of such therapy.
  
  
  METHODS
  We report the case of a 67-year-old, current-smoking male with stage-IV HER2-positive gastric cancer who suffered right middle cerebral artery (MCA) embolism after trastuzumab + chemotherapy. He received trastuzumab and cisplatin on Day 1, followed by a continuous 5-fluorouracil infusion for 5 days as a first-line treatment. Four days after chemotherapy initiation, he presented with left hemiplegia, and brain magnetic resonance imaging and magnetic resonance angiography revealed a right MCA occlusion. No further chemotherapy was administered because of worsening performance status.
  
  
  CONCLUSIONS
  The present case, possibly the first such reported case, suggests the risk of development of embolism after trastuzumab + chemotherapy in HER2-positive advanced gastric cancer, although other factors should be considered.
authors.affiliation: Department of Medical Oncology, Kinki University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-8511, Japan. takahama_t@dotd.med.kindai.ac.jp.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Takahama
authors.affiliation: Department of Medical Oncology, Kinki University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-8511, Japan. takedamasa2004@yahoo.co.jp.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Takeda
authors.affiliation: Department of Medical Oncology, Kinki University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-8511, Japan. shin12470123@yahoo.co.jp.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Nishina
authors.affiliation: Department of Medical Oncology, Kinki University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-8511, Japan. nakagawa@med.kindai.ac.jp.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Nakagawa
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D014408:Biomarkers, Tumor / Q000235:genetics; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D017809:Fatal Outcome; D005472:Fluorouracil / Q000008:administration & dosage / Q000009:adverse effects; D015870:Gene Expression; D006801:Humans; D020766:Intracranial Embolism / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology / Q000473:pathology*; D008113:Liver Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000556:secondary*; D008207:Lymphatic Metastasis; D008297:Male; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000473:pathology; D009367:Neoplasm Staging; D011859:Radiography; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000235:genetics; D013274:Stomach Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology*; D000068878:Trastuzumab / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D002945:Cisplatin; D005472:Fluorouracil; D018719:Erb-b2 Receptor Tyrosine Kinases; D000068878:Trastuzumab; C508053:ERBB2 protein, human