Department of Internal Medicine, University of California, Riverside School of Medicine, Riverside, California; and.
Department of Medical Oncology and Therapeutics Research.
J Natl Compr Canc Netw. 2022 Aug;20(8):857-865. doi: 10.6004/jnccn.2022.7023.
Despite the use of first-line therapies like fluoropyrimidine and platinum-based cytotoxic chemotherapy, gastric cancer (GC) continues to carry a poor prognosis. Recent subgroup analyses of first-line phase III trials have demonstrated that patients with microsatellite instability-high (MSI-H) metastatic GC derive significant improvement in survival rates when immune checkpoint inhibitors (ICIs) are combined with chemotherapy compared with chemotherapy alone. However, it remains to be seen whether the success of ICIs in the metastatic setting can be translated into earlier stages of GC with resectable disease. We report 6 cases of locally advanced, nonmetastatic MSI-H GC that all demonstrated favorable response following treatment with pembrolizumab in addition to neoadjuvant chemotherapy. With the exception of immune-related colitis in one patient, pembrolizumab was well-tolerated. To our knowledge, this is the first reported US case series of patients treated with an ICI in combination with neoadjuvant chemotherapy for advanced, nonmetastatic, resectable or unresectable MSI-H GC.
尽管采用了氟嘧啶和基于铂的细胞毒性化疗等一线疗法，但胃癌（GC）的预后仍然很差。最近对一线 III 期试验的亚组分析表明，与单独化疗相比，微卫星不稳定高（MSI-H）转移性 GC 患者在联合化疗时使用免疫检查点抑制剂（ICI）可显著提高生存率。然而，ICI 在转移性环境中的成功是否可以转化为可切除疾病的 GC 早期阶段仍有待观察。我们报告了 6 例局部晚期、非转移性 MSI-H GC 病例，这些病例在接受帕博利珠单抗联合新辅助化疗治疗后均表现出良好的反应。除了 1 例患者出现免疫相关性结肠炎外，帕博利珠单抗的耐受性良好。据我们所知，这是首例在美国报告的将 ICI 与新辅助化疗联合用于治疗晚期、非转移性、可切除或不可切除的 MSI-H GC 的病例系列。
