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Doctors at a private hospital have reported an exceptional case of long-term survival in a patient with HER2-positive metastatic gastric adenocarcinoma, demonstrating how a personalised multidisciplinary treatment strategy combining targeted therapy, surgery, precision radiotherapy, and minimally invasive local ablative treatment can achieve prolonged disease control, even in advanced-stage gastric cancer.
The patient, a 65-year-old man, presented with abdominal pain, vomiting, significant weight loss, and metastatic disease involving the liver in 2018. Diagnostic evaluation confirmed HER2-positive metastatic gastric adenocarcinoma, a highly aggressive form of stomach cancer with a historically poor prognosis. Patients with metastatic gastric cancer typically have a five-year survival rate of less than 10%. The patient was initiated on first-line treatment with CAPOX chemotherapy (capecitabine and oxaliplatin) combined with trastuzumab, a targeted anti-HER2 therapy. The treatment resulted in a remarkable reduction in both the primary tumour and liver metastases, enabling the patient to transition to long-term maintenance therapy. Following sustained disease control, the multidisciplinary team performed conversion surgery, removing the primary stomach tumour after achieving an excellent systemic response. Subsequent imaging confirmed complete disappearance of liver lesions. Over the following years, the patient experienced two isolated episodes of disease progression in 2021 and in 2024. Instead of changing the entire systemic treatment, the treating team successfully managed these recurrences using highly targeted local therapies. The first recurrence near the surgical site was treated with precision radiotherapy, while a later solitary liver lesion was successfully managed with microwave ablation. Throughout this period, HER2-targeted therapy was continued, allowing the patient to maintain excellent quality of life and sustained disease control. Commenting on the case, Dr. Shyam Aggarwal, Chairman, Medical Oncology, Sir Ganga Ram Hospital, said, "Systemic treatment of gastric cancer has evolved significantly over the years. Today, four key biomarkers--HER2, MSI, CPS, and Claudin 18.2--play a crucial role in determining the most appropriate first-line treatment strategy. The addition of targeted therapies alongside chemotherapy has transformed outcomes for many patients with stomach cancer. This case highlights how precision medicine and a personalised, multidisciplinary approach can help achieve long-term disease control, even in patients with advanced metastatic disease." Approximately 15-20% of gastric cancers overexpress the HER2 protein, making them eligible for targeted therapies such as trastuzumab. Advances in molecular diagnostics, imaging, and multidisciplinary cancer care are increasingly enabling clinicians to tailor treatment strategies for selected patients with advanced disease. This remarkable case demonstrates that maintaining HER2-directed therapy, combined with carefully timed local interventions for isolated recurrences, can provide durable clinical benefit far beyond the outcomes traditionally expected in metastatic gastric cancer. The doctors believe that this case reinforces the importance of precision oncology and individualised treatment planning, offering renewed hope for patients with advanced HER2-positive gastric cancer. (ANI)
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