Middle age male with recently diagnosed distal gastric cancer (presumably adenocarcinoma), found to have hepatic metastasis during planned open distal gastrectomy which was aborted. Now has J-tube and feeding. Planned for palliative radiotherapy to gastric outlet obstruction, followed by ramucirumab, capecitabine, and cisplatin.
- Outlet obstruction- consider stenting by gastroenterologist.
- Chemo- ramucirumab is approved for 2nd line therapy, would treat first with FOLFOX (add trastuzumab if HER2 positive), if progress, use ramucirumab plus paclitaxel as 2nd line, or look for clinical trial.
- the clinical trial I mentioned is for HER2 negative patients, but there is no site in Canada. This immunotherapy trial is as following:
KEYNOTE-059 is recruiting patient like him, please contact following center to see if he is eligible and there is a spot for him:
|Kirkland, Quebec, Canada, H9H 3L1|
|Contact: Medical Information Centre Centre de l'information medicale de Merck Canada 514-428-8600 / 1-800-567-2594|
- if patient's biopsy sample is enough for more test, recommend immunohistochemistry staining for DNA mismatch enzyme expression. If expression is deficient, it's likely he will benefit from immunotherapy such as anti-PD1 (nivolumab or pembrolizumab, currently available only on clinical trial for gastric cancer).