[A case of unresectable gastric cancer treated with triplet combination chemotherapy with itraconazole and conversion surgery]. 2022

Miyuki Sawasaki, and Toshinari Shiba, and Yuji Hayakawa, and Ayako Kakuno, and Yukio Oosaki
Department of Internal Medicine, Meiwa Hospital.

A 73-year-old woman visited our hospital due to carcinoembryonic antigen (CEA) level elevation (110ng/ml). She underwent an upper gastrointestinal endoscopy (EGD), enhanced computed tomography (CT), and positron emission tomography (PET) -CT. She was diagnosed with type 3 esophagogastric junction cancer with paraaortic lymph node (LN) metastases at stage IVA (cT3N4M0). She underwent triplet combination chemotherapy with itraconazole (ITCZ):nab-paclitaxel, oxaliplatin, and S-1 with ITCZ. After six cycles of this regimen, the CEA level was within normal range, and EGD and PET-CT showed no evidence of malignancy. She underwent laparoscopic proximal gastrectomy and lower esophagectomy. The surgical specimen revealed no residual tumor (pathological complete response). Three months later, her CEA level increased to 60.5ng/ml, and she had longitudinal LN recurrence. However, she took S-1 orally for 11 cycles, and the recurrent metastatic LNs improved. She received chemotherapy, including nivolumab followed by ramucirumab and nab-paclitaxel with ITCZ. The CEA level returned to the normal range, and PET-CT showed no evidence of malignancy. Her progression has been stable for 45 months after diagnosis. In summary, we encountered a case of unresectable gastric cancer with conversion surgery after triplet combination chemotherapy with ITCZ.

UI MeSH Term Description Entries
D005260 Female Females
D005743 Gastrectomy Excision of the whole (total gastrectomy) or part (subtotal gastrectomy, partial gastrectomy, gastric resection) of the stomach. (Dorland, 28th ed) Gastrectomies
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000072078 Positron Emission Tomography Computed Tomography An imaging technique that combines a POSITRON-EMISSION TOMOGRAPHY (PET) scanner and a CT X RAY scanner. This establishes a precise anatomic localization in the same session. CT PET,CT PET Scan,PET CT Scan,PET-CT,PET-CT Scan,Positron Emission Tomography-Computed Tomography,CT PET Scans,CT Scan, PET,CT Scans, PET,PET CT Scans,PET Scan, CT,PET Scans, CT,PET-CT Scans,Scan, CT PET,Scan, PET CT,Scan, PET-CT,Scans, CT PET,Scans, PET CT,Scans, PET-CT
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly
D000971 Antineoplastic Combined Chemotherapy Protocols The use of two or more chemicals simultaneously or sequentially in the drug therapy of neoplasms. The drugs need not be in the same dosage form. Anticancer Drug Combinations,Antineoplastic Agents, Combined,Antineoplastic Chemotherapy Protocols,Antineoplastic Drug Combinations,Cancer Chemotherapy Protocols,Chemotherapy Protocols, Antineoplastic,Drug Combinations, Antineoplastic,Antineoplastic Combined Chemotherapy Regimens,Combined Antineoplastic Agents,Agent, Combined Antineoplastic,Agents, Combined Antineoplastic,Anticancer Drug Combination,Antineoplastic Agent, Combined,Antineoplastic Chemotherapy Protocol,Antineoplastic Drug Combination,Cancer Chemotherapy Protocol,Chemotherapy Protocol, Antineoplastic,Chemotherapy Protocol, Cancer,Chemotherapy Protocols, Cancer,Combinations, Antineoplastic Drug,Combined Antineoplastic Agent,Drug Combination, Anticancer,Drug Combination, Antineoplastic,Drug Combinations, Anticancer,Protocol, Antineoplastic Chemotherapy,Protocol, Cancer Chemotherapy,Protocols, Antineoplastic Chemotherapy,Protocols, Cancer Chemotherapy
D013274 Stomach Neoplasms Tumors or cancer of the STOMACH. Cancer of Stomach,Gastric Cancer,Gastric Neoplasms,Stomach Cancer,Cancer of the Stomach,Gastric Cancer, Familial Diffuse,Neoplasms, Gastric,Neoplasms, Stomach,Cancer, Gastric,Cancer, Stomach,Cancers, Gastric,Cancers, Stomach,Gastric Cancers,Gastric Neoplasm,Neoplasm, Gastric,Neoplasm, Stomach,Stomach Cancers,Stomach Neoplasm
D017964 Itraconazole A triazole antifungal agent that inhibits cytochrome P-450-dependent enzymes required for ERGOSTEROL synthesis. Orungal,R-51211,Sporanox,R 51211,R51211

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