The Effectiveness of Hepatic Arterial Infusion Chemotherapy with 5-Fluorouracil/Cisplatin and Systemic Chemotherapy with Ramucirumab in Alpha-Fetoprotein-Producing Gastric Cancer with Multiple Liver Metastases

Alpha-fetoprotein- (AFP-) producing gastric cancer (AFPGC) is characterized by a high incidence of liver and lymph node metastases and poor prognosis. Although several case reports have described successful multidisciplinary treatment, there are currently no standard therapies for AFPGC. A 57-year-old man presented with upper abdominal pain. His serum AFP level was extremely high (588.9 ng/mL). Computed tomography (CT) revealed multiple liver metastases with several lesions at an imminent risk of rupture. Five days after admission to our hospital, one lesion ruptured. Transarterial chemoembolization (TACE) of the ruptured tumor was performed, and hepatic arterial infusion chemotherapy (HAIC) with 5-fluorouracil (5-FU)/cisplatin (CDDP) to the other liver metastases was administered. The patient's AFP levels decreased to 297.1 ng/mL. Gastrointestinal endoscopy revealed Borrmann type 2 lesion in the pyloric portion. Pathological examination indicated hepatoid adenocarcinoma of the stomach and metastatic liver. The final diagnosis was AFPGC and multiple liver metastases. The patient underwent systemic chemotherapy with capecitabine/CDDP (cape/CDDP) for three months. His AFP level increased extremely, and CT revealed progression of the liver metastases. TACE was performed, and HAIC (5FU/CDDP) was administered to the progressive lesion of the liver. Originating from the gastric lesion, a distal gastrectomy and D2 + alpha lymph node resection were performed. One month after the operation, the patient underwent systemic chemotherapy with paclitaxel/ramucirumab (PTX/RAM). After eight cycles of chemotherapy, his AFP level had declined, and CT showed a complete response. After three months of drug withdrawal, the patient has undergone maintenance treatment with RAM. It has been two years since the recurrence. Our experience suggests that HAIC with 5-FU/CDDP and systemic chemotherapy with a regimen including RAM may be an effective treatment for AFPGC.