Challenges in the management of advanced gastric cancer: a case report with emphasis on the side effects of chemotherapy and the importance of multidisciplinary care

Abstract

Introduction: Gastric cancer is one of the leading causes of cancer-related deaths worldwide, especially in advanced stages, when curative treatment becomes limited. Chemotherapy is a fundamental part of the management of this condition, but side effects, such as peripheral neuropathy and febrile neutropenia, represent significant challenges in controlling the disease. This paper discusses a clinical case of advanced gastric cancer and the multidisciplinary management required to optimize treatment and ensure the patient's quality of life. Case Report: A 63-year-old male patient was diagnosed with stage IV gastric cancer with metastases to regional lymph nodes and liver. He started chemotherapy based on the FOLFOX regimen (oxaliplatin, 5-fluorouracil, and leucovorin). After the third cycle, he presented symptoms of peripheral neuropathy and, during the fourth cycle, he developed fever and severe neutropenia, requiring hospitalization. Treatment was adjusted to reduce oxaliplatin doses and include support with hematopoietic growth factors. Design and Methods: A detailed review of chemotherapy treatment protocols for advanced gastric cancer was performed, focusing on the FOLFOX and CAPOX regimens, and the most common side effects, such as peripheral neuropathy and febrile neutropenia. The search was conducted in academic databases, such as PubMed and Scopus, using specific terms related to the management of these adverse effects. Discussion: Advanced gastric cancer often requires aggressive chemotherapy treatment, but side effects can limit treatment continuity. Oxaliplatin-induced peripheral neuropathy is a common side effect and may be irreversible, and febrile neutropenia is a serious complication that requires immediate intervention. The management of these side effects requires a multidisciplinary approach, including oncologists, nutritionists, psychologists, and nurses, who must work together to adjust the treatment, minimize adverse effects, and ensure the best possible quality of life for the patient. Conclusion: The management of advanced gastric cancer requires not only an effective therapeutic strategy, but also strict control of side effects. A multidisciplinary approach is essential to provide adequate care and optimize clinical outcomes, providing patients with a better quality of life, even in advanced stages of the disease. Coordination between specialties is crucial for successful treatment.