We report on a patient who underwent total
gastrectomy with D2
lymph node dissection for metastatic
gastric cancer. We administered S-1 at 60 mg/m² as postoperative
adjuvant chemotherapy. Six months after surgery, recurrence was detected in the para-aortic lymph node. As a first-line treatment for the recurrent
cancer, the patient underwent
capecitabine/CDDP
therapy(
capecitabine 1,800 mg/m², CDDP 60 mg/m²). A significant reduction in the recurrent lymph nodes was observed by CT after 6 months of administration, resulting in 24 months of progression-free survival. S-1/CDDP
therapy is recommended as a first-line
chemotherapy for recurrent gastric
carcinoma in the Japanese
gastric cancer treatment guidelines. Likewise, single agent S-1 administration is recommended as postoperative
adjuvant chemotherapy for advanced
gastric cancer patients. However, in cases of recurrence after S-1
therapy, there is insufficient evidence on the efficacy of S-1/CDDP; thus, the type of administration and time to recurrence could be considered for optimization. We identified a case of
gastric cancer showing response to first-line
capecitabine/CDDP
therapy after lymph node recurrence following the administration of S-1 as postoperative
adjuvant chemotherapy. Since
capecitabine and S-1 differ in their mechanisms of action and as predictive factors for
therapeutic effect,
capecitabine may be an efficient option in cases of S-1 failure. The present case suggests that
capecitabine/CDDP
therapy may be an effective treatment for S-1 pretreated patients with advanced or metastatic
gastric cancer.