Workup and management of initially metastatic advanced gastric cancer in 2025. EndoTODAY 이준행

[Gastric cancer 958. Workup and management of initially metastatic advanced gastric cancer in 2025.] - 終

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This case shows the typical workup and management of initially metastatic advanced gastric cancer in 2025. The imaging workup changes rather slowly, but the pathologic evaluation and choice of anti-cancer medication changes so quickly. Most recent change was claudin18.

There was a huge ulceroinfiltrative mass lesion on the lesser curvature side of the antrum. The histology was poorly differentiated tubular adenocarcinoma with PD-L1 CPS 90, HER2 positive, claudin18 negative and intact MLH1. In the CT scan, gastric wall was thickened with hepatopancreatic invasion with multiple perigastric nodes and a few small metastatic nodules in the liver. In the PET/CT scan, hepatic lesions looked more prominent than CT. It’s a cT4bN2+M1 case, and the initial regimen was XELOX with Opdivo. In this case we did not perform EUS.

In this case PD-L1 (28-8) staining was very strong. The CPS score was 90!