Li Wei, Li Qian, Yu Yiyi, Wang Yan, Chen Erbao, Chen Lingli, Wang Zhiming, Cui Yuehong, Liu Tianshu
Department of Medical Oncology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.
Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China.
Cancer Manag Res. 2020 Nov 2;12:11113-11119. doi: 10.2147/CMAR.S276969. eCollection 2020.
Alpha-fetoprotein-producing gastric cancer (AFPGC) and hepatoid adenocarcinoma of stomach (HAS) are rare types of gastric cancer, with specific clinical manifestations and poor prognosis. The standardized treatment process of such cancers remains elusive. We aim to investigate the efficacy of immunotherapy combined with chemotherapy on patients with AFPGC or HAS.
AFPGC and HAS patients who underwent immunotherapy and/or chemotherapy as the first-line treatment at our institute from June 2016 to December 2018 were enrolled in this observational study. Their clinicopathological characteristics, serum AFP level and treatment methods were collected. The progression-free survival (PFS) and overall survival (OS) were analyzed and compared between patients who received immunotherapy plus chemotherapy and those received chemotherapy.
A total of 21 patients with advanced AFPGC or HAS were included in the study and the median follow-up time was 28.0 months. Of the 21 patients, 7 patients received immunotherapy of PD-1 antibody (nivolumab) plus chemotherapy and 14 patients as control received chemotherapy with or without Herceptin/Apatinib. The median progression-free survival (mPFS) time was 5.0 months (4.3 months in the control group and 22.0 months in the immunotherapy group). The median overall survival (mOS) time of the control group was 16.0 months (14.0 months in chemotherapy alone subgroup, 20.0 months in chemotherapy plus Apatinib or Herceptin subgroup), while the mOS of patients receiving immunotherapy was not reached.
This study suggested PD-1 checkpoint inhibitor plus chemotherapy could benefit AFPGC and HAS patients. Its mechanism of action warrants further investigation.
甲胎蛋白产生性胃癌（AFPGC）和胃肝样腺癌（HAS）是胃癌的罕见类型，具有特定临床表现且预后较差。此类癌症的标准化治疗流程仍不明确。我们旨在研究免疫疗法联合化疗对AFPGC或HAS患者的疗效。
2016年6月至2018年12月期间在我院接受免疫疗法和/或化疗作为一线治疗的AFPGC和HAS患者纳入本观察性研究。收集他们的临床病理特征、血清甲胎蛋白水平及治疗方法。分析并比较接受免疫疗法加化疗的患者与接受化疗的患者的无进展生存期（PFS）和总生存期（OS）。
本研究共纳入21例晚期AFPGC或HAS患者，中位随访时间为28.0个月。21例患者中，7例接受PD-1抗体（纳武单抗）免疫疗法加化疗，14例作为对照接受含或不含赫赛汀/阿帕替尼的化疗。中位无进展生存期（mPFS）时间为5.0个月（对照组为4.3个月，免疫疗法组为22.0个月）。对照组的中位总生存期（mOS）时间为16.0个月（单纯化疗亚组为14.0个月，化疗加阿帕替尼或赫赛汀亚组为20.0个月），而接受免疫疗法患者的mOS未达到。
本研究提示PD-1检查点抑制剂加化疗可使AFPGC和HAS患者获益。其作用机制值得进一步研究。
