title: [HER2-Positive Advanced Gastric Cancer with Disseminated Intravascular Coagulation and Diffuse Bone Marrow Carcinomatosis Successfully Treated with S-1/Trastuzumab Chemotherapy--A Case Report].
abstract: Trastuzumab, a humanized monoclonal antibody against human epidermal growth factor receptor 2 (HER2), has been proven to result in a survival benefit for the treatment of patients with HER2-positive advanced gastric cancer (AGC). However, data are lacking for the treatment of those with disseminated intravascular coagulation (DIC) and diffuse bone marrow carcinomatosis. A 77-year-old woman presented with back pain and fatigue since 2 months. Esophagogastroduodenoscopy showed a scirrhous lesion in the gastric corpus, which was biopsied and identified as signet-ring cell carcinoma with HER2 overexpression on immunohistochemistry. Laboratory testing, bone scintigraphy, and bone marrow biopsy were conducted, and she was diagnosed with HER2-positive AGC with DIC and diffuse bone marrow carcinomatosis. She underwent chemotherapy with the following regimen: oral administration of 80 mg/m2 S-1 for 2 weeks and 6 mg/kg trastuzumab infusion on day 6 every 3 weeks, which significantly improved the DIC. She was discharged from the hospital 73 days after admission and survived for 438 days after diagnosis. To the best of our knowledge, this is the first case report in which HER2-positive AGC complicated by DIC with diffuse bone marrow carcinomatosis was successfully treated with combined chemotherapy consisting of S-1 plus trastuzumab.
authors.affiliation: 1Dept. of Internal Medicine, Chugoku Central Hospital.
authors.forename: Satoru
authors.initials: S
authors.lastname: Senoo
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Mannami
authors.forename: Tomoki
authors.initials: T
authors.lastname: Tamura
authors.forename: Nobukiyo
authors.initials: N
authors.lastname: Fujiwara
authors.forename: Genyo
authors.initials: G
authors.lastname: Ikeda
authors.forename: Minori
authors.initials: M
authors.lastname: Komoda
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Ohtawa
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Fujimoto
authors.forename: Naohiro
authors.initials: N
authors.lastname: Sato
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kambara
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Waku
authors.forename: Masaichi
authors.initials: M
authors.lastname: Kenmotsu
authors.forename: Etsuko
authors.initials: E
authors.lastname: Kurimoto
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Okada
authors.forename: Shingo
authors.initials: S
authors.lastname: Harita
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Sonobe
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001706:Biopsy; D019046:Bone Marrow Neoplasms / Q000188:drug therapy* / Q000556:secondary; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000556:secondary; D018279:Carcinoma, Signet Ring Cell / Q000737:chemistry / Q000188:drug therapy*; D004211:Disseminated Intravascular Coagulation / Q000188:drug therapy / Q000209:etiology*; D004338:Drug Combinations; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D010094:Oxonic Acid / Q000008:administration & dosage; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000032:analysis; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000473:pathology; D005641:Tegafur / Q000008:administration & dosage; D000068878:Trastuzumab / Q000008:administration & dosage
chemical_list: D000925:Anticoagulants; D004338:Drug Combinations; D010094:Oxonic Acid; D018719:Erb-b2 Receptor Tyrosine Kinases; D005641:Tegafur; D000068878:Trastuzumab; C079198:S 1 (combination); C508053:ERBB2 protein, human