Efficacy of chemotherapy following nivolumab in metastatic gastric cancer

Abstract

Abstract Background Immuno-checkpoint inhibitors, nivolumab targeting programmed cell death 1 (PD-1) can result in significant benefit to gastric cancer. Some recent data about non-small cell lung cancer suggest anti-PD-1 therapy may enhance sensitivity to subsequent chemotherapy. To date, there are no reports on treatment efficacy after failure of PD-1 blockade in advanced gastric cancer. Therefore, we aimed to report the efficacy of chemotherapy after progressive disease on nivolumab. Methods We have retrospectively reviewed data of all patients in metastatic gastric cancer who received chemotherapy in our hospital and investigated the efficacy and adverse events of chemotherapy after progression on nivolumab. Results Between September 2017 and January 2019, 29 patients received nivolumab for metastatic gastric cancer. 11 patients received subsequent treatment following nivolumab. The median age was 70. Performance status (0/1/2); 2/8/1. Previous treatment regimens (2/3/4/5); 4/3/2/1. Chemotherapy regimen (irinotecan / nab-paclitaxel±ramcirumab / CAPOX±trastuzumab / SOX+trastuzumab); 3/5/2/1. Overall Response rate was 27%. 2 patients for nab-PTX+ramcirumab and 1patient of CAPOX+trastuzumab had a PR, 1patient for nab-PTX+ramcirumab had a SD, 5 patients had a PD and 1 patient had a NE. Median PFS was 3.3 (95% CI. 0.8-5.5) months. Median OS was 8.0 (95%CI. 2.3-11.6) months. One patient developed Gr3 dysfunction of liver maybe due to nivolumab. Other adverse events were mild. Conclusions We evaluated the efficacy of chemotherapy after progression on nivolumab. Further investigation is warranted to reveal an immunotherapy-induced chemosensitization effect.