Mixed adenocarcinoma-neuroendocrine gastric cancer progressing after multiple treatments

What happened, in summary

A 60-year-old man developed more than a month of difficulty eating with intermittent stomach pain. Endoscopy found an ulcerated tumor around the gastric cardia and fundus, and biopsy initially suggested poorly differentiated adenocarcinoma. CT did not show distant metastasis.

He underwent total gastrectomy with D2 lymph-node dissection and hyperthermic intraperitoneal chemotherapy. The surgical specimen showed a rare mixed adenocarcinoma-neuroendocrine carcinoma with lymph-node involvement and invasion through the gastric wall. HER2 testing was negative.

After surgery, he received four cycles of capecitabine plus oxaliplatin. The cancer nevertheless progressed and a liver metastasis developed, establishing Stage IV disease. Radiofrequency ablation was used on the liver lesion, but the cancer continued to progress. He then received six cycles of paclitaxel plus cisplatin and developed severe bone-marrow suppression, with later imaging again showing progression.

At the latest update, he had started apatinib after progression through multiple prior treatments and remained in active treatment for Stage IV disease.