What happened, in summary

A 70-year-old man presented with 3 months of weight loss and early satiety. Endoscopy showed a large gastric tumor extending from the gastroesophageal junction toward the lower stomach. Biopsy confirmed poorly differentiated gastric adenocarcinoma, and HER2 testing was negative. CT showed peritoneal and retroperitoneal nodal metastases, establishing Stage IV disease.

He started combination chemotherapy with epirubicin, oxaliplatin and capecitabine. Five days after the first cycle, he developed sudden severe abdominal and back pain. Urgent CT angiography found extensive new arterial thrombosis in the abdominal aorta and branches. Chemotherapy was stopped, and he was treated with anticoagulation and supportive care. He recovered without surgery and was discharged on long-term enoxaparin.

The patient remained eager to continue cancer treatment. Because of the thrombosis risk, the platinum-based regimen was not restarted. Six weeks after the acute event, he began single-agent docetaxel. At the latest follow-up, he remained well and had experienced no further complications.