title: A case report of targeted therapy with apatinib in a patient with advanced gastric cancer and high serum level of alpha-fetoprotein.
abstract: BACKGROUND
  Alpha-fetoprotein (AFP) is an important marker for hepatocellular carcinoma, and the detection of serum AFP is currently the principle method for the diagnosis of hepatocellular carcinoma. The prevalence of gastric cancer (GC) with high level of serum AFP is extremely rare, but has unique clinical features.
  
  
  METHODS
  We herein present a rare case with GC and high level of serum AFP. A 64-year-old Chinese female underwent gastrectomy was diagnosed as gastric adenocarcinoma and the pathological stage was T1bN0M0, IA. With the progression of disease, the tumor widely metastasized and the serum AFP level increased progressively with the highest level of 3396 ng/mL. She successively entered into 3 lines palliative systematic chemotherapy and fourth-line targeted therapy of apatinib, a small molecule tyrosine kinase inhibitor targeting vascular endothelial growth factor receptor-2. Although previous studies suggested that the prognosis of this special type of GC was poor, this patient lived for 22 months after tumor transfer. Apatinib kept her progression-free survival for 5 months, and the overall survival was 4.5 years.
  
  
  CONCLUSIONS
  So, we speculate that maybe we can focus apatinib on serum AFP elevated GC patients.
authors.affiliation: Department of Oncology Department of Pathology, Xin Hua Hospital affiliated To Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Xue-Ru
authors.initials: XR
authors.lastname: Zhu
authors.forename: Mei-Ling
authors.initials: ML
authors.lastname: Zhu
authors.forename: Qing
authors.initials: Q
authors.lastname: Wang
authors.forename: Wen-Ji
authors.initials: WJ
authors.lastname: Xue
authors.forename: Yi-Wei
authors.initials: YW
authors.lastname: Wang
authors.forename: Rui-Fen
authors.initials: RF
authors.lastname: Wang
authors.forename: Si-Yu
authors.initials: SY
authors.lastname: Chen
authors.forename: Lei-Zhen
authors.initials: LZ
authors.lastname: Zheng
mesh_terms: D000230:Adenocarcinoma / Q000097:blood / Q000188:drug therapy* / Q000601:surgery; D005260:Female; D005743:Gastrectomy; D006801:Humans; D008875:Middle Aged; D058990:Molecular Targeted Therapy; D011725:Pyridines / Q000494:pharmacology / Q000627:therapeutic use*; D013274:Stomach Neoplasms / Q000097:blood / Q000188:drug therapy* / Q000601:surgery; D040301:Vascular Endothelial Growth Factor Receptor-2 / Q000037:antagonists & inhibitors; D000509:alpha-Fetoproteins / Q000378:metabolism*
chemical_list: D011725:Pyridines; D000509:alpha-Fetoproteins; C553458:apatinib; D040301:Vascular Endothelial Growth Factor Receptor-2