Chubenko Viacheslav A, Navmatulya Alexander Y, Gerk Ivan A, Sarmatov Artem A, Egorenkov Vitaliy V, Shelekhova Ksenia A, Zykov Evgeny N, Chernobrivceva Vera V, Volkov Nikita M, Moiseyenko Vladimir M
Department of Chemotherapy, Napalkov State Budgetary Healthcare Institution, Saint Petersburg Clinical, Scientific, and Practical Center for Specialised Types of Medical Care (Oncological), Saint Petersburg, RUS.
Department of Abdominal Surgery, Napalkov State Budgetary Healthcare Institution, Saint Petersburg Clinical, Scientific, and Practical Center for Specialised Types of Medical Care (Oncological), Saint Petersburg, RUS.
Cureus. 2024 May 30;16(5):e61344. doi: 10.7759/cureus.61344. eCollection 2024 May.
Purpose This research work evaluates monotherapy with checkpoint inhibitors (CPI). as a neoadjuvant treatment for patients with Microsatellite Instability-High (MSI-H) locally advanced gastric cancer. Methods Here we present the results of the retrospective study from Napalkov Cancer Center over 4.5 years on patients with MSI-H locally advanced gastric cancer. A total of 566 patients were analyzed, 18 of whom were included in the research, focusing on clinical response rate, surgical pathology, 'watch and wait' strategy, and safety outcomes on an exploratory basis. Patients were assigned to four to eight neoadjuvant cycles of CPI, followed by surgery. Results The objective response to neoadjuvant CPI in patients with MSI-H gastric cancer was 77.8%. Complete response was achieved in five (27.8%) and partial response in nine (50%) patients, accordingly. Surgery was performed on 14 patients. Complete margin-free (R0) resection rates were 100%. Downstaging was observed in 12 out of 14 patients. Histopathologic complete response rates (pathologic complete response or Tumor Regression Grade-major response (TRG1)) were achieved in eight (57.1%) patients. No disease progression was detected with a median follow-up of 33.7 months (4.4-55.7 months). Clinically significant adverse events were not observed. Conclusion CPI in a neoadjuvant setting for patients with MSI-H locally advanced gastric cancer is highly effective and safe.
目的 本研究工作评估了检查点抑制剂（CPI）单药治疗作为微卫星高度不稳定（MSI-H）局部晚期胃癌患者新辅助治疗的效果。方法 在此，我们展示了纳帕尔科夫癌症中心对MSI-H局部晚期胃癌患者进行的超过4.5年的回顾性研究结果。共分析了566例患者，其中18例纳入研究，探索性地关注临床缓解率、手术病理、“观察等待”策略及安全性结果。患者接受4至8个周期的CPI新辅助治疗，随后进行手术。结果 MSI-H胃癌患者对新辅助CPI的客观缓解率为77.8%。分别有5例（27.8%）患者达到完全缓解，9例（50%）患者达到部分缓解。14例患者接受了手术，切缘阴性（R0）切除率为100%。14例患者中有12例观察到降期。8例（57.1%）患者实现了组织病理学完全缓解率（病理完全缓解或肿瘤消退分级-主要缓解（TRG1））。中位随访33.7个月（4.4 - 55.7个月）未检测到疾病进展。未观察到具有临床意义的不良事件。结论 对于MSI-H局部晚期胃癌患者，新辅助使用CPI是高效且安全的。
