Clin Transl Oncol (2008) 10:182-184 DOI 10.1007/s12094-008-0178-9 Abstract There is no standard chemotherapy regimen in advanced gastric cancer with poor performance status and hepatic dysfunction. New chemotherapeutical agents and targeted therapy have demonstrated promising results in terms of efficacy and safety in phase II clinical trials. We report the case of a 68-year-old man with stage IV gastric cancer and severe hepatic dysfunction due to liver metas- tases treated with a combination of oxaliplatin, 5-fluo- rouracil and cetuximab. Keywords Gastric cancer · Oxaliplatin · Cetuximab · Hepatic dysfunction Introduction Gastric cancer is the fourth most common neoplasm and the second leading cause of cancer death worldwide [1, 2]. The prognosis for gastric cancer is poor, with a five-year survival of 10–20%, the only curative treatment being sur- gery. Approximately 60–70% of patients have stage III or IV disease at diagnosis. Systemic chemotherapy can pro- vide symptom palliation, and improve quality of life and survival as compared to best supportive care [3]. There is no standard regimen in advanced gastric cancer, although combination chemotherapy provides higher response rates and modest improvement in survival compared to a single agent. Promising results have been reported with regimens based on oxaliplatin and capecitabine [4] with at least the same efficacy and a better toxic profile, as well as new combinations with targeted therapy with bevacizumab [5] and cetuximab [6]. In the context of severe hepatic dys- function and poor performance status, the indication of chemotherapy is uncertain. We present our experience in the treatment of advanced gastric cancer with poor performance status and severe he- patic dysfunction with a new combination regimen with oxaliplatin, 5-fluorouracil and cetuximab. Case report A 68-year-old man was diagnosed of advance gastric cancer poorly differentiated of the fundus with lung, liver and abdominal lymph node metastases at presentation. For the previous three months he had referred epigastric abdominal pain, nausea and vomiting and weight loss of 8 kg. The physical examination revealed a 3-cm hepatomegaly and ECOG 2. The biochemical test showed: bilirubin 2.6 mg/dl, GOT 125 UI/l, GPT 89 UI/l, FA 359 U/l, LDH 5.878 UI/l, GGT 1.252 UI/l and the rest of the values were normal. Tumour markers were normal except CA-19.9 279.8 U/ml (range 0–35 U/ml). Before starting chemotherapy, severe hypercalcaemia developed without bone metastases (normal bone scan), which was controlled with zoledronic acid, corticoids, hydration and diuretics. However bilirubin reached 11.6 mg/dl without dilation of the biliary tract and LDH increased rapidly till 7290 UI/l due to tumour progression. The patient received chemotherapy in a biweekly schedule with oxali- platin 60 mg/m 2 day 1, 5-fluorouracil 200 mg/m 2 in continuous infu- sion days 1–7 and cetuximab 400 mg/m 2 loading dose followed by maintenance dose of 250 mg/m 2 weekly. Dosing adjustment was re- quired because of hepatic dysfunction and poor performance status. After the first cycle diarrhoea and asthenia grade II were observed and the 5-fluorouracil continuous infusion was stopped. Afterwards 5-fluorouracil 400 mg/m 2 in bolus was administrated in a biweekly schedule. The week after the first dose of chemotherapy the bilirubin First-line treatment of advanced gastric cancer and hepatic dysfunction with oxaliplatin, 5-fluorouracil and cetuximab Andrés Jesús Muñoz Martín · Virginia Martínez Marín · Juan Luis Arranz Cózar · Luis Cabezón Gutiérrez · Ricardo González del Val Subirats · Pilar García Alfonso Received: 17 October 2007 / Accepted: 12 December 2007 CASE REPORTS A.J. Muñoz Martín () · V. Martínez Marín · J.L. Arranz Cózar · L. Cabezón Gutiérrez · R. González del Val Subirats · P. García Alfonso Servicio de Oncología Médica Hospital General Universitario Gregorio Marañón C/ Doctor Esquerdo, 46 ES-28007 Madrid, Spain e-mail: ajmunoz.hgugm@salud.madrid.org