A 78-year-old man underwent R0 resection for gastric cancer with solitary peritoneal metastasis. Postoperatively, first-line therapy was capecitabine/cisplatin, followed by weekly nab-paclitaxel (nab-PTX) as second-line therapy. After 22 courses, weekly nab-PTX therapy was halted due to no visible lesions. Two years later, peritoneal and lung metastases appeared, after S-1/oxaliplatin therapy, weekly nab-PTX/ramucirumab therapy was restarted. After 18 courses, all lesions disappeared but reappeared 4 months later. Weekly nab-PTX/ramucirumab therapy was restarted, and after nine courses, all metastases disappeared. The nab-PTX dosage was reduced from 90 to 40 mg/m2/day due to adverse events. The patient survived 5 years and 9 months post-surgery and 2 years and 9 months post-recurrence. As far as searched, the total number of nab-PTX administrations was 141, the highest for elderly patients treated with nab-PTX. By adjusting the dosage and monitoring adverse events, long-term chemotherapy based on nab-PTX could lead to long-term survival in elderly patients recurrent with gastric cancer.
Yamazaki et al. (Sun,) studied this question.