Gan to kagaku ryoho. Cancer & chemotherapy · 2025
[A Case of Locally Advanced Gastric Cancer with Pathological Complete Response after Chemotherapy Including Immune Checkpoint Inhibitors].
СтатьяКлинический случайАннотация на английскомНазвание и аннотация: Перевод пока не подготовлен
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Nagata Tomoyuki, Arimura Yuya, Kojo Masahiro, Takemoto Kenichi, Naito Kei, Nakano Katsunori
Аннотация
BACKGROUND: Recent advances in chemotherapy for advanced gastric cancer have increased the feasibility of conversion surgery after tumor downstaging. Among these advances, immune checkpoint inhibitors(ICIs)have shown promising results, particularly in MSI-high tumors.
CASE PRESENTATION: A 65-year-old man presented with upper abdominal discomfort. Imaging and endoscopic evaluations revealed type 3 gastric cancer with peritoneal dissemination, diagnosed as cT4bN2+M1(P1), Stage Ⅳ. Biomarker analysis showed MSI-high and HER2-negativity. The patient initially received 3 courses of SOX plus nivolumab, but treatment was then switched to SOX alone due to Grade 1 interstitial pneumonia. After recovery, SOX plus pembrolizumab was administered for 3 additional courses. Imaging revealed a marked response, and curative-intent conversion surgery was planned. The operation started under robotic assistance, but was converted to laparotomy due to severe adhesions. Distal gastrectomy with transverse colectomy and D2 lymphadenectomy was performed, and histopathology confirmed pathological complete response(pCR). The patient is currently on S-1 monotherapy and remains recurrence-free under regular follow-up.
CONCLUSION: This case demonstrates the potential of ICI-combined chemotherapy in achieving pCR in MSI-high, HER2-negative unresectable gastric cancer. Accumulation of similar cases is needed to establish optimal postoperative management strategies.
CASE PRESENTATION: A 65-year-old man presented with upper abdominal discomfort. Imaging and endoscopic evaluations revealed type 3 gastric cancer with peritoneal dissemination, diagnosed as cT4bN2+M1(P1), Stage Ⅳ. Biomarker analysis showed MSI-high and HER2-negativity. The patient initially received 3 courses of SOX plus nivolumab, but treatment was then switched to SOX alone due to Grade 1 interstitial pneumonia. After recovery, SOX plus pembrolizumab was administered for 3 additional courses. Imaging revealed a marked response, and curative-intent conversion surgery was planned. The operation started under robotic assistance, but was converted to laparotomy due to severe adhesions. Distal gastrectomy with transverse colectomy and D2 lymphadenectomy was performed, and histopathology confirmed pathological complete response(pCR). The patient is currently on S-1 monotherapy and remains recurrence-free under regular follow-up.
CONCLUSION: This case demonstrates the potential of ICI-combined chemotherapy in achieving pCR in MSI-high, HER2-negative unresectable gastric cancer. Accumulation of similar cases is needed to establish optimal postoperative management strategies.