Complete remission of metastatic gastric cancer, how did he do it?

Gastric cancer is a malignant tumor with a high incidence in China, and surgical treatment is the most basic treatment method for the radical cure of gastric cancer

Recently, nivolumab, represented by PD-1 inhibitors, has emerged in the treatment of gastric cancer.

Metastatic gastric cancer achieved 32 months without recurrence

In July 2019, a 66-year-old retired police officer was admitted to the hospital with symptoms including epigastric fullness, dysphagia, and significant weight loss

After gastroscopy, it was found that there was a mass extending to the gastric cardia, which was pathologically determined to be poorly differentiated gastric adenocarcinoma, and there was a metastatic lesion in the liver

Because the patient developed acute gastric hemorrhage, laparoscopic total gastrectomy, regional lymph node dissection, and esophagojejunostomy were performed

After the operation, the patient started to use the chemotherapy drugs Aswan (S-1) and oxaliplatin.

Since the patient prefers to remove the residual disease, he starts to receive SOX chemotherapy (oxaliplatin, Sigio), in combination with nivolumab (200 mg every 2 weeks), after 4 cycles Liver metastases were significantly reduced

Due to the emergence of immune pneumonia, the latter treatment only used SOX chemotherapy drugs, and the immunotherapy drugs were suspended
.

After receiving 16 cycles of SOX chemotherapy, the liver metastases were surgically removed, and pathology confirmed that no tumor cells were found except for the removal of a large number of lymphocytes
.

PET-CT also showed complete disappearance of liver metastases
.

After multidisciplinary discussions, all examinations confirmed that the patient's primary and secondary lesions were completely removed, so all anti-tumor treatments were stopped accordingly
.

 Figure 1.
Surgical resection of liver metastases when pneumonia has resolved

The patient was discharged postoperatively without any further medication and achieved a complete remission (no visible tumor lesions), which was maintained for 32 months without recurrence
.

For metastatic gastric cancer, this is a miracle
.

 Figure 2.
Timeline of patient treatment

revelation

The patient in this case had low PD-L1 expression and tumor mutation burden, but achieved complete remission through palliative surgery, PD-1 inhibitor combined with chemotherapy
.

Perhaps the initial surgical treatment has played a certain role in assisting the subsequent chemotherapy combined with immunotherapy, or the resection of tumor lesions has played a certain role in the human body's repair mechanism and immune stress mechanism? These are questions that can be further researched and discussed
.

In the process of tumor treatment, there are still many unsolved mysteries waiting for us to explore
.

It is believed that more and more drugs and treatment measures will continue to emerge in the future, bringing hope to more patients
.

For more tumor treatment cases, please pay attention to the Cancer Degree Public Account
.

Reference: Peilin Dai, et al.
, Case Report: Complete Remission of a Patient With Metastatic Gastric Cancer Treated With Nivolumab Combined With Chemotherapy After Palliative Surgery, Front Immunol.
2022 Jun 29

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