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Gastric carcinosarcoma with FGFR2 amplification under long-term control with pazopanib: a case report and literature
Hirokatsu Hayashi1, Akitaka Makiyama2, Naoki Okumura1
1Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu, Japan.
Background:
Gastric carcinosarcoma is most frequently diagnosed at an advanced stage when the tumor is generally large with invasion into other organs, lymph node metastasis, and distant metastasis. Standard chemotherapy has not been established, and surgery is the only curative treatment. Here, we present a case of postoperative recurrence of gastric carcinosarcoma under long-term tumor control with pazopanib.
Case Presentation:
A 77-year-old man was referred to our hospital because of nausea and vomiting. Computed tomography and upper gastrointestinal endoscopy revealed a type 1 tumor arising from the gastric antrum and extending into the duodenal bulb. He underwent distal gastrectomy (D2) with Roux-en-Y reconstruction. Histopathologically, the tumor had mixed adenocarcinoma and sarcoma components. According to the tumor-node-metastasis classification, the diagnosis was primary gastric carcinosarcoma pT1bN1M0 stage IB. Liver metastasis was detected 2 months after surgery; multiple lung metastases were detected 17 month after surgery. A genomic profiling test was performed using liver specimens as the patient became refractory to chemotherapy commonly used for gastric cancer, and the test revealed FGFR2 amplification along with TP53 R209*, AKT3 N127D, NOTCH1 A2036T, and POLD1 M161I. The patient was treated with pazopanib (800 mg/daily), and the tumor growth was controlled for 11 months.
Conclusions:
We report a case of postoperative recurrence of gastric carcinosarcoma under long-term tumor control with pazopanib. This case suggested that pazopanib may be effective in treating gastric carcinosarcoma.
Insights
Gastric carcinosarcoma is a rare cancer. Pazopanib demonstrated long-term tumor control in a patient with advanced gastric carcinosarcoma, suggesting its potential efficacy in managing this challenging disease.
Area of Science:
- Oncology
- Gastroenterology
- Genomic Medicine
Background:
- Gastric carcinosarcoma is typically diagnosed at advanced stages, presenting challenges due to metastasis and lack of established chemotherapy.
- Surgery remains the primary curative treatment, but recurrence is a significant concern.
Observation:
- A 77-year-old male presented with advanced gastric carcinosarcoma (pT1bN1M0, Stage IB) with subsequent liver and lung metastases.
- Genomic profiling revealed FGFR2 amplification, TP53, AKT3, NOTCH1, and POLD1 mutations in refractory metastatic disease.
- The patient received pazopanib (800 mg/daily) for recurrent disease.
Findings:
- Pazopanib treatment resulted in 11 months of tumor growth control in a patient with metastatic gastric carcinosarcoma.
- This indicates a potential therapeutic benefit of pazopanib in managing advanced or recurrent gastric carcinosarcoma.
Implications:
- This case suggests pazopanib may be an effective treatment option for gastric carcinosarcoma, particularly in cases with specific genomic alterations like FGFR2 amplification.
- Further investigation into pazopanib's role in gastric carcinosarcoma management is warranted.
