Clinical example of long-term control of disseminated signet-ring cell carcinoma of the stomach against the background of chemotherapy of the second line of treatment in combination with bevacizumab

• Main Authors: T. A. Titova, N. S. Besova, E. V. Artamonova
• Format: Article
• Language: Russian
• Published: Remedium Group LLC 2019-12-01
• Series: Медицинский совет
• Subjects: stomach cancer; bevacizumab; second line of therapy
• Online Access: https://www.med-sovet.pro/jour/article/view/5308

The standard of treatment of the second line of disseminated stomach cancer is palliative chemotherapy with paclitaxel in combination with ramucirumab. Vascular endothelial growth factor A (VEGF-A) is a key regulator of blood vessel growth and its connection to the corresponding receptors of VEGFR1/2 leads to the activation of neoangiogenesis. In patients with disseminated stomach cancer, the level of VEGF-A rs25648 has a negative impact on both survival without progression of the disease and on overall survival. The antitumor activity of neoangiogenesis inhibitors in the second line of treatment may be related to a higher concentration of VEGF-A, the level of which, in turn, correlates with the volume of tumor tissue. In a small study of the second phase, the addition of bevacizumab to docetaxel in the second line of treatment of patients with disseminated stomach cancer allowed to achieve tumor growth control in 48% of patients. Meta-analysis of 7 studies (n = 905) showed that the use of two-component modes based on irinotecan in the second line in comparison with irinotecan monotherapy allows to increase significantly the survival rate without progression. This clinical observation illustrates this approach. Patients with signet-ring cell disseminated stomach cancer after rapid progression on the background of the first line of chemotherapy with docetaxel, oxaliplatin and 5-fluorouracil were prescribed chemotherapy of the second line in combination with bevacizumab. It is the second line of treatment that allowed to achieve long-term control of the disease, equal to 18 months, with a life expectancy of 30 months. When analyzing a clinical case, the justification of the patient’s treatment tactics, the choice of two-component mode of chemotherapy and the use of bevacizumab was carried out.