What happened, in summary

A 55-year-old woman with gastric adenocarcinoma underwent surgery in March 2013, but the operation was stopped when extensive peritoneal metastases were found. Pathology from a peritoneal nodule showed signet-ring cell carcinoma. HER2 testing was IHC 2+, while FISH was negative for HER2 amplification.

She received 6 cycles of oxaliplatin plus S-1 and achieved stable disease, then continued S-1 as maintenance treatment. When gastrointestinal obstruction developed about a year later, she received albumin-bound paclitaxel plus oxaliplatin and again achieved stable disease. The cancer later progressed, and she received supportive care before starting apatinib in December 2014.

During apatinib treatment, gastrointestinal bleeding developed, followed by sudden severe abdominal pain. Emergency surgery found a gastric perforation, extensive abdominal tumor deposits and a metastatic signet-ring cell tumor in the ileum. Surgeons repaired the stomach and removed the ileal tumor. The bleeding and perforation could not be clearly attributed to cancer progression, apatinib, or a combination of both. She developed septic shock and multiple organ dysfunction and died on February 23, 2015.