Nozawa Kazuki, Narita Yukiya, Hosoda Waki, Muro Kei
Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan.
Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan.
Case Rep Oncol. 2020 Nov 30;13(3):1381-1386. doi: 10.1159/000510405. eCollection 2020 Sep-Dec.
The introduction of immune checkpoint inhibitors has redefined the treatment strategy and changed the way tumor assessments are made because of its response pattern. Studies have suggested that initiating chemotherapy after checkpoint inhibitors may have high anti-tumor activity in some cancer types. This response pattern has not been reported in patients with gastric cancer, and particularly for the combination of trifluridine/tipiracil. A 69-year-old man presented at follow-up for metastatic gastric cancer being treated with nivolumab, an anti-PD-1 antibody. Computed tomography of the liver showed a rapid 4-fold growth of the metastasis compared with baseline measurements taken while receiving paclitaxel and ramucirumab. It met the definition of a phenomenon called hyperprogressive disease. Nivolumab was discontinued, and he was switched to trifluridine/tipiracil. The liver metastasis was shrunk markedly after 2 months with improvement in his performance status and laboratory data. Sequential therapy starting with immune checkpoint inhibitors followed by cytotoxic agents such as trifluridine/tipiracil may have an apparent efficacy in gastric cancer even though prior immunotherapy demonstrates hyperprogressive disease.
免疫检查点抑制剂的引入重新定义了治疗策略，并因其反应模式改变了肿瘤评估方式。研究表明，在检查点抑制剂治疗后启动化疗在某些癌症类型中可能具有较高的抗肿瘤活性。这种反应模式在胃癌患者中尚未见报道，尤其是对于曲氟尿苷/替匹嘧啶联合治疗。一名69岁男性因转移性胃癌接受抗PD-1抗体纳武单抗治疗，在随访时前来就诊。肝脏计算机断层扫描显示，与接受紫杉醇和雷莫西尤单抗治疗时的基线测量值相比，转移灶迅速增长了4倍。这符合一种称为超进展性疾病现象的定义。纳武单抗停药，他转而接受曲氟尿苷/替匹嘧啶治疗。2个月后肝脏转移灶明显缩小，其身体状况和实验室数据有所改善。即使先前的免疫治疗显示为超进展性疾病，以免疫检查点抑制剂开始，随后使用细胞毒性药物如曲氟尿苷/替匹嘧啶的序贯治疗在胃癌中可能具有明显疗效。
