The case was a ６９-year-old man, and gastric cancer （papillary adenocarcinoma） was diagnosed by a close inspection of the abdominal pain in ２００８, and it was our department introduction. Show the type ０‐IIa＋IIc like advanced lesion of gastric middle body gastrointestinal endoscope, and CT showed no regional lymph node and distant metastases, and we diagnosed it as c-T２ （MP）, N０, M０, stageIB. We performed laparoscopic distal gastrectomy with D２ dissection, and in pathology, acknowledgment of severe lymph node metastases was obtained, and diagnosed it as T３ （SE）, N２, M０, stageIIIB. We gave adjuvant chemotherapy with S-１and Cisplatin for ５ cycles, and maintenance S-１alone up to ２４ months after surgery.
There was no recurrence for ３９ months after surgery. But multiple metastases to lung recurrence was acknowledged and we performed S-１/Docetaxel therapy for ６ cycles, which lead to progressive disease. Then we performed Trastuzumab/Capecitabine/Cisplatin chemotherapy （HXP）, the anti-tumor effect was good, and after １４ months later, showed a liver metastasis, but the tolerability was good. Generally, it is said that the chemotherapy is poor at an effect after the second line treatment, but HXP may be useful even in the second line chemotherapy
