Stage IV gastric cancer with low platelets managed so chemotherapy could continue

What happened, in summary

A 69-year-old woman was investigated for unexplained weight loss and found to have Stage IV gastric cancer invading the splenic hilum, with splenomegaly, gastric varices and increasing ascites. Bleeding from the gastric tumor required frequent transfusions. Palliative radiation controlled the bleeding, after which S-1 plus oxaliplatin chemotherapy was started.

Within 2 months, her platelet count fell substantially. Treatment was changed to S-1 alone, but thrombocytopenia worsened and the gastric varices enlarged. Because the low platelet count was preventing chemotherapy from continuing, she underwent partial splenic embolization, a procedure that reduces blood flow to part of the enlarged spleen. About 70% of the spleen was embolized without a serious complication.

Two weeks later, her platelet count had risen from about 50,000 to 310,000 per microliter and the varices had decreased, allowing S-1 plus oxaliplatin to restart. Four months after the embolization, ascites developed and treatment was changed to ramucirumab plus paclitaxel. At 6 months, thrombocytopenia had not returned and chemotherapy was still continuing. The underlying gastric cancer nevertheless progressed, and she later died from the disease.