A 58-year-old male with advanced
gastric cancer underwent a total
gastrectomy after
neoadjuvant chemotherapy with
paclitaxel and
cisplatin. The
combination chemotherapy was resumed postoperatively as
adjuvant chemotherapy. Although no recurrence was observed after 6 months of
adjuvant chemotherapy,the patient elected to receive further
adjuvant chemotherapy with an oral
drug. On the night of November 9,2006, he began taking S-1 at a dose of 50 mg twice daily. Fifty minutes after taking the first 50 mg of S-1,he experienced a squeezing
chest pain at rest that was later accompanied by diaphoresis and
nausea. The
pain continued for approximately one hour,but had subsided by the time he reached an emergency room. Coronary angiography revealed a 50% eccentric
stenosis in the proximal site of the right coronary artery,but there was no coronary lesion which could caused
myocardial ischemia. Cardiac scintigraphy using 123I-BMIPP (123I-labeled beta-methyl-p-iodophenyl-pentadecanoic acid) showed a decreased uptake of
BMIPP within the posterior wall,which improved one month later,so transient
myocardial ischemia was confirmed. Since vasospastic angina related to S-1 administration was highly suspected,re-administration of S-1 was not performed. The patient is not currently receiving
chemotherapy and remains under surveillance for relapse.