Journal of Digestive Cancer Research

Korean Society of Gastrointestinal Cancer Research (대한소화기암연구학회)
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A Case of Palliative Chemotherapy of Advanced Gastric Cancer with Multiple Hepatic Metastasis

다발성 간 전이가 동반된 진행성 위암의 고식적 항암치료 1례

  • Hae Jin Shin (Division of Gastroenterology, Department of Internal Medicine, Chungnam National University School of Medicine) ;
  • Hyun Yong Jeong (Division of Gastroenterology, Department of Internal Medicine, Chungnam National University School of Medicine) ;
  • Hee Seok Moon (Division of Gastroenterology, Department of Internal Medicine, Chungnam National University School of Medicine) ;
  • Jae Kyu Sung (Division of Gastroenterology, Department of Internal Medicine, Chungnam National University School of Medicine) ;
  • Sun Hyung Kang (Division of Gastroenterology, Department of Internal Medicine, Chungnam National University School of Medicine)
  • 신해진 (충남대학교 의학전문대학원 내과학교실, 소화기내과) ;
  • 정현용 (충남대학교 의학전문대학원 내과학교실, 소화기내과) ;
  • 문희석 (충남대학교 의학전문대학원 내과학교실, 소화기내과) ;
  • 성재규 (충남대학교 의학전문대학원 내과학교실, 소화기내과) ;
  • 강선형 (충남대학교 의학전문대학원 내과학교실, 소화기내과)
  • Received : 2015.05.25
  • Accepted : 2015.06.21
  • Published : 2015.06.30
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Abstract

We report a case of a 55-year-old man who diagnosed with advanced gastric cancer (AGC), with A review of the literature. A 55-year old man was transferred to our hospital for further evaluation and treatment after being diagnosed with adenocarcinoma through endoscopic biopsy during a regular health examination. An abdominal computed tomography (CT) showed AGC, stage IIA (T3N3M0), while an endoscopic examination showed AGC, Borrmann type 2. The patient is currently under observation after undergoing radical subtotal gastrectomy with gastroduodenostomy and subsequent administration of oral chemotherapeutic agents. As an abdominal CT response assessment performed after surgery revealed new metastasis to the liver, the patient received palliative chemotherapy as progressive disease was suspected. After receiving chemotherapy in the order of FOLFOX (5-fluorouracil (5-FU)) + Leucovorin + Oxaliplatin), FOLFIRI (5-FU + Leucovorin + Irinotecan), EAP-II (Etoposide + Doxorubicin + Cisplatin), ELF (Etoposide + Leucovorin + 5-FU), TS-1 (Tegafur + Gimeracil) + Cisplatin, an abdominal CT response assessment showed progressive disease for which the regimen was altered to PFL (Paclitaxel + 5-FU + Leucovorin). The patient has currently completed his second cycle of chemotherapy and after an abdominal CT response assessment, further course of therapy will be decided.

전이성 위암에서 1차 항암화학요법은 생존 기간을 연장시키고 삶의 질을 향상시키므로 환자의 전신 상태가 양호하다면 표준 요법으로 시행되어야 하며, 국내에서는 fluoropyrimidine과 platinum의 병합 요법이 가장 흔하게 사용된다. 또한 1차 치료에 실패한 위암 환자에서 2차 항암화학요법은 표준 치료이며, 환자의 전신 상태에 따라 그 시행을 적극적으로 고려해야 한다. HER2 양성 위암에서는 trastuzumab 포함 복합 항암화학요법을 시행해야 하며, 진행성 위암으로 진단 시 먼저 HER2/neu 과발현 여부를 확인하는 것이 매우 중요하다. 최근 혈관 신생 성장인자와 관련된 ramucirumab의 항암효과에 대한 임상 결과가 보고되었고, 현재 진행성 위암 환자를 대상으로 C-MET, PI3K, FGFR 및 immune checkpoint 등과 연관된 여러 새로운 표적 치료제에 대한 임상 연구가 활발히 진행되고 있으므로 이들 연구 결과가 임상 현장에 적용될 경우 향후 환자들의 생존과 삶의 질을 향상시키며, 더 나아가 환자 개개인의 분자적, 유전적 특성에 맞는 치료를 할 수 있을 것으로 전망되는 바이다. 저자들은 전신 상태가 비교적 양호하고 고령이 아닌 55세의 남자 환자가 T3N3M0 (Stage IIA)의 진행성 위암을 진단받고 수술적 치료 후 추적 관찰 도중에 간에 다발성의 전이성 병변들이 새롭게 확인되어 고식적인 항암화학요법의 실제 임상에서의 적용을 보고하고자 본 증례를 문헌 고찰과 함께 보고하는 바이다.

Keywords

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