A 67-year-old woman was referred to our hospital for type 1
gastric cancer. We diagnosed the patient with advanced
gastric cancer (tub2>por, HER2-positive), and the clinical findings were T4aN1M1 (lung), Stage Ⅳ. The patient had
cancer cachexia. As first-line
chemotherapy, a regimen consisting of
capecitabine (X) (1,600 mg/m2/day, days 1-14),
cisplatin (P) (60 mg/m2/day, day 1), and
trastuzumab (H) (8 mg/kg/day>6 mg/kg/day, day 1) was administered every 3 weeks and repeated 6 times. After receiving 6 courses, the patient's general condition and
cancer cachexia symptoms improved. The size of the primary lesion significantly decreased, and lung
metastasis was not visible on a PET scan. Simultaneously, a new 0-Ⅱc
tumor was detected in the cardia, and a biopsy revealed a
malignant lymphoma. Total
gastrectomy and D2
lymph node dissection without
splenectomy were performed. The final diagnosis was T4aN0M0.
After treatment, the
tumor was histologically evaluated as Grade 1b, and the remnant
cancer cells were found to be HER2-negative (loss of HER2). The patient has been alive for 5 months and is receiving
adjuvant chemotherapy comprising
capecitabine and
trastuzumab. Following
chemotherapy containing
trastuzumab, the patient with
cachexia who was diagnosed with unresectable HER2-positive advanced
gastric cancer showed improvement in the
cachexia symptoms and the disappearance of lung
metastasis.