[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-457210-105":59,"doc-detail-457210-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","multidisciplinary-team-approach-of-treatment-of-a-metastatic-gastric-carcinoma-during-pregnancy-a-case-report","Multidisciplinary team approach of treatment of a metastatic gastric carcinoma during pregnancy - A case report","","A 39-year-old pregnant woman at 26 weeks 4 days presented with metastatic gastric carcinoma complicated by pleural effusion and ascites, respiratory failure, pain, and weight loss. An MDT convened intensivists, oncology, pharmacy, gynecology, and nursing to weigh maternal and fetal risks using a health and safety matrix. After stabilization, FOLFOX chemotherapy was initiated while nivolumab was excluded; 5-FU levels were monitored. Following clinical improvement and careful surveillance, a cesarean delivery was performed and post-partum therapy continued.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/multidisciplinary-team-approach-of-treatment-of-a-metastatic-gastric-carcinoma-during-pregnancy-a-case-report/457210/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/multidisciplinary-team-approach-of-treatment-of-a-metastatic-gastric-carcinoma-during-pregnancy-a-case-report/457210.png","ImageObject",300,407,{"name":92,"@type":93},"Melati","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-04","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",14,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What clinical situation prompted the MDT decision in this case?","Question",{"text":113,"@type":114},"The patient, 26 weeks and 4 days pregnant, developed metastatic gastric carcinoma with pleural effusion, ascites, respiratory failure, pain, and weight loss, requiring stabilization before treatment planning.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"Why was nivolumab excluded and how was chemotherapy selected?",{"text":118,"@type":114},"Nivolumab was considered too high risk for the unborn child, so the team selected FOLFOX (5-fluorouracil, folinic acid, oxaliplatin) based on a literature- and experience-based health and safety risk matrix.",{"name":120,"@type":111,"acceptedAnswer":121},"How was fetal safety addressed during treatment and delivery?",{"text":122,"@type":114},"The gynecologist monitored the unborn child, 5-FU levels were monitored to assess kinetics, drains were removed after response, and a cesarean section was performed in week 33 to balance chemotherapy risks with prematurity.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},457210,1791036889,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":29,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145,"preview_page_count":4},962085570644,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","Multidisciplinary team approach of treatment of a metastatic gastric carcinoma during pregnancy: a case report  \nJob F. H. Eijsink1,2^, Joost N. Udo3, Jan Gerard Maring3^, Rieneke T. Lugtenberg4, Helle-Brit Fiebrich4  \n1Department of Innovation and Science, Isala, Zwolle, The Netherlands; 2Department of Pharmacy, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands; 3Department of Pharmacy, Isala, Zwolle, The Netherlands; 4Department of Oncology, Isala, Zwolle, The Netherlands Contributions: (I) Conception and design: JG Maring, HB Fiebrich, JFH Eijsink; (II) Administrative support: None; (III) Provision of study materials or patients: None; (IV) Collection and assembly of data: JN Udo, JFH Eijsink; (V) Data analysis and interpretation: JFH Eijsink; (VI) Manuscript  \nwriting: All authors; (VII) Final approval of manuscript: All authors.  \nCorrespondence to: Job F. H. Eijsink, PharmD, PhD. Department of Innovation and Science, Isala, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands; Department of Pharmacy, Canisius Wilhelmina Ziekenhuis, Nijmegen, [The Netherlands. Email: j.f.h.eijsink@isala.nl](The Netherlands. Email: j.f.h.eijsink@isala.nl).  \nBackground: A 39-year-old woman, G2P0M0, 26 weeks and 4 days pregnant, presented at the hospital with nausea, abnormal increase in abdominal size, respiratory failure due to pleural effusion and ascites, pain and weight loss. She was diagnosed with metastatic gastric carcinoma [signet ring cell carcinoma, human epidermal growth factor receptor 2 (HER2)-negative, programmed death-ligand 1 (PD-L1) combined positive score (CPS) 8, proficient mismatch repair (pMMR)] . Oxygen therapy through a high-flow nasal cannula was started at the intensive care unit and drainage of ascites and pleural effusion was performed. A multidisciplinary team (MDT) was convened to discuss if gastric cancer treatment could safely be started after clinical improvement and, if so, what the consequences could be for the mother and the unborn child.  \nCase Description: An MDT consisting of intensivists, oncologists, clinical pharmacists, gynecologistsand nurses was assembled to collaboratively decide, together with the patient and her partner, on the best treatment strategy. A health and safety risk matrix based on literature and experience in practice was used to weigh the risks associated with cancer treatment. Once the patient was stabilized, it was decided to initiate 5-fluorouracil (5-FU), folinic acid and oxaliplatin (FOLFOX) chemotherapy based on the health and safety matrix. Nivolumab was considered to pose too high risks for the unborn and was therefore excluded. The gynecologist closely monitored the unborn child. 5-FU levels were monitored to assess 5-FU kinetics during pregnancy. A normal therapeutic AUC of 25.3 mg·L/h (ref 20–30 mg·L/h) after 46 hours treatment with  \n4,000 mg 5-FU was found. The patient tolerated the chemotherapy well and showed a good clinical and radiological response. After the first course of chemotherapy, the ascites and pleural drains were removed. In week 33 of the pregnancy, a cesarean section was performed to achieve an optimal balance between risks of chemotherapy and premature birth. A healthy boy was delivered. Post-partum treatment was continued with  \nFOLFOX-nivolumab.  \nConclusions: This case report demonstrates that, with a multidisciplinary approach and careful monitoring, metastatic gastric cancer can be successfully managed during pregnancy. The good response to FOLFOX therapy and the safe delivery of the child underscore the significance of tailored treatment plans in  \nsuch complex cases.  \nKeywords: Maternal oncology treatment; therapeutic drug monitoring (TDM); multidisciplinary; case report  \nSubmitted Apr 12, 2025. Accepted for publication Aug 07, 2025. Published online Dec 23, 2025.  \ndoi: 10.21037/jgo-2025-288  \nView this article at: [https://dx.doi.org/10.21037/jgo-2025-288](https://dx.doi.org/10.21037/jgo-2025-288)  \n^ ORCID: Job F. H. Eijsink, 000","cbCaikEuzLAwpMV2","https://ap.wps.com/l/cbCaikEuzLAwpMV2","pdf",180180,"English","# Background\n## Case Description\n## Conclusions\n## Introduction\n## Highlight box\n## Key findings\n## What is known and what is new?","[{\"question\":\"What clinical situation prompted the MDT decision in this case?\",\"answer\":\"The patient, 26 weeks and 4 days pregnant, developed metastatic gastric carcinoma with pleural effusion, ascites, respiratory failure, pain, and weight loss, requiring stabilization before treatment planning.\"},{\"question\":\"Why was nivolumab excluded and how was chemotherapy selected?\",\"answer\":\"Nivolumab was considered too high risk for the unborn child, so the team selected FOLFOX (5-fluorouracil, folinic acid, oxaliplatin) based on a literature- and experience-based health and safety risk matrix.\"},{\"question\":\"How was fetal safety addressed during treatment and delivery?\",\"answer\":\"The gynecologist monitored the unborn child, 5-FU levels were monitored to assess kinetics, drains were removed after response, and a cesarean section was performed in week 33 to balance chemotherapy risks with prematurity.\"}]","Multidisciplinary team approach of treatment of a metastatic gastric carcinoma during pregnancy - A case report | PDF",1790748629,15]