Abstract
BackgroundAlthough a recent randomized clinical trial has demonstrated that the objective response rate to nivolumab for metastatic gastric cancer was 11.2%, there was no patients confirmed complete response. Herein, we report on a case of liver metastasis arising from early gastric cancer in which a complete clinical response was achieved to nivolumab as third-line therapy.Case presentationA 77-year-old man was referred to Kochi Medical School Hospital for the treatment of liver metastases from gastric cancer. The patient had undergone laparoscopic total gastrectomy with regional lymph node dissection 30 months prior for early gastric cancer, with a final diagnosis of T1N0M0, stage IA. The patient developed solitary splenic metastasis measuring 42 mm 28 months later and underwent splenectomy because there was no evidence of further metastatic lesions in any other organ. The patient was treated with S-1 plus oxaliplatin based on negative immunohistochemical staining of the resected specimens for human epidermal growth factor receptor 2 (HER2). Four months after the splenectomy, the patient developed multiple liver metastases and was treated with ramucirumab plus paclitaxel. Because of disease progression, the patient was administered 3 mg/kg, i.v., nivolumab every 2 weeks. After 4 cycles of systemic treatment using nivolumab, abdominal computed tomography revealed marked shrinkage of the liver metastases. After 12 cycles of nivolumab, the liver metastases had disappeared completely. The patient did not develop any adverse reactions, including immune-reactive adverse events, during treatment. The patient continues to receive nivolumab, and there is no evidence of disease recurrence in the 8-month period since starting nivolumab.ConclusionsTo the best of our knowledge, this is the first case report in the English literature of a gastric cancer patient achieving a complete clinical response to nivolumab, and highlights the potential for successful treatment of metastatic gastric cancer using nivolumab.
Highlights
A recent randomized clinical trial has demonstrated that the objective response rate to nivolumab for metastatic gastric cancer was 11.2%, there was no patients confirmed complete response
After four cycles of systemic treatment with nivolumab, abdominal computed tomography (CT) revealed a marked shrinkage of liver metastases, which indicated a partial response according to the Response Evaluation Criteria in Solid Tumors (RECIST 1.1) [9], with a 55.0% decrease in liver target lesions compared with baseline (Fig. 2)
In this case report, we present a rare case of liver metastases following curative resection of early gastric cancer in which a complete clinical response was achieved to nivolumab as third-line therapy
Summary
The response of the present patient to nivolumab indicates that it may prolong the survival of patients with metastatic or recurrent gastric cancer. Nivolumab exhibited good safety and tolerability profiles in the present case, indicating its potential use for the successful treatment of metastatic gastric cancer. All authors read and approved the final manuscript. Ethics approval and consent to participate This study was carried out in accordance with the principles of the Declaration of Helsinki. Author details 1Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi 783-8505, Japan. Author details 1Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi 783-8505, Japan. 2Cancer Treatment Center, Kochi Medical School Hospital, Nankoku, Kochi, Japan. 3Department of Human Health and Medical Sciences, Kochi Medical School, Nankoku, Kochi, Japan
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