Koizumi Noriaki, Kashiwagi Saori, Ogino Shinpei, Kamada Yosuke, Fujiki Hiroshi, Sakakura Chouhei
Dept. of Surgery, Akashi City Hospital.
Gan To Kagaku Ryoho. 2020 Nov;47(11):1624-1626.
A 77-year-old man was admitted to our hospital with symptoms of epigastralgia and vomiting. Detailed investigation revealed unresectable advanced gastric cancer accompanied by multiple lymph node metastases and invasion of the pancreas(UM, type 3, cT4b, N3, M0, Stage ⅢC). The patient received nivolumab immunotherapy after first-line S-1 plus oxaliplatin(SOX)chemotherapy and second-line nab-paclitaxel(PTX)plus ramucirumab(RAM)chemotherapy. Remarkable tumor reduction was observed after 3 courses of nivolumab immunotherapy, and the patient subsequently underwent radical total gastrectomy with splenectomy and D2 lymphadenectomy. Histopathological examination of the resected stomach showed a near complete response, and only small metastatic foci remained in No. 2 lymph nodes, resulting in R0 resection. The patient was followed up without adjuvant therapy, and he is alive 6 months after the treatment without any symptoms of recurrence. The mechanism of action of immune checkpoint inhibitors is fundamentally different from that of conventional cytotoxic chemotherapeutic agents. Recently, several reports have described good responses to immune checkpoint inhibitors in cases where conventional chemotherapy has been unsuccessful. When predictive biomarkers of response to immune checkpoint inhibitors are identified, a combination therapy of preceding immunotherapy and subsequent surgery might provide an efficient radical therapeutic effect even in cases of unresectable advanced gastric cancer.
一名77岁男性因上腹部疼痛和呕吐症状入院。详细检查发现为不可切除的晚期胃癌，伴有多发淋巴结转移和胰腺侵犯（UM，3型，cT4b，N3，M0，ⅢC期）。该患者在一线S-1联合奥沙利铂（SOX）化疗及二线白蛋白结合型紫杉醇（PTX）联合雷莫西尤单抗（RAM）化疗后接受了纳武利尤单抗免疫治疗。纳武利尤单抗免疫治疗3个疗程后观察到肿瘤显著缩小，随后患者接受了根治性全胃切除术、脾切除术及D2淋巴结清扫术。切除胃的组织病理学检查显示接近完全缓解，仅在第2组淋巴结中残留小的转移灶，实现了R0切除。患者未接受辅助治疗进行随访，治疗后6个月仍存活，无任何复发症状。免疫检查点抑制剂的作用机制与传统细胞毒性化疗药物根本不同。最近，有几份报告描述了在传统化疗失败的病例中对免疫检查点抑制剂有良好反应。当确定免疫检查点抑制剂反应的预测生物标志物时，先行免疫治疗和后续手术的联合治疗即使在不可切除的晚期胃癌病例中也可能提供有效的根治性治疗效果。
