Stage IV gastric cancer with low platelets managed so chemotherapy could continue — Case 2

What happened, in summary

A 75-year-old woman was found to have Stage IV gastric cancer invading the splenic vein, with splenomegaly but no evidence of liver cirrhosis. She started trastuzumab with S-1 and oxaliplatin chemotherapy. After 3 courses she developed black stools, and endoscopy showed recurrent bleeding from regrowth of the stomach tumor.

Palliative radiation successfully controlled the bleeding. Around 2 months after starting chemotherapy, however, her platelet count had fallen to about 55,000 per microliter, making it difficult to continue systemic treatment. The low platelet count was attributed to hypersplenism related to tumor invasion of the splenic vein.

She underwent partial splenic embolization, with about 60% of the spleen treated and no serious adverse events. Two weeks later, the platelet count had risen from about 66,000 to 230,000 per microliter. Thrombocytopenia did not recur after the procedure, allowing cancer treatment to resume. At the latest report, she was receiving ramucirumab plus paclitaxel as second-line therapy.