PDF(Pubmed)
Abstract：
The standard of care for patients with operable gastric adenocarcinoma is perioperative chemotherapy and surgical resection. The deficient mismatch repair (dMMR)/microsatellite instability (MSI-H) phenotype is a major predictive biomarker for immune checkpoint inhibitors (ICIs) efficacy in advanced disease. Several phase II and III trials suggest a promising future role of immunotherapy with or without chemotherapy in the neoadjuvant/adjuvant setting, especially in MSI-H localized gastric adenocarcinomas. We present a 38-year-old man diagnosed in March 2022 with poorly differentiated gastric adenocarcinoma clinical stage III (cT4 N0 M0) with deficiency of MLH1 and PMS2, combined positive score (CPS) of 100 and negative HER2 immunohistochemistry, had poor tumor response to preoperative 5-FU, leucovorin, oxaliplatin, and docetaxel (FLOT). It was considered unresectable because of the involvement of the colon, mesocolon, duodenum, pancreas, and retroperitoneum. Then, first-line systemic treatment with 5-FU, leucovorin, and oxaliplatin (FOLFOX)-nivolumab was initiated in August 2022, with a significant radiologic tumor reduction after six cycles, allowing a curative surgery in March 2023 with complete pathologic tumor response, followed by capecitabine and nivolumab for one year, maintaining radiological remission in the last follow-up in April 2024. With this case report, we conclude that it is likely that chemoimmunotherapy or immunotherapy alone may be alternative neoadjuvant treatment choices for MSI-H locally advanced gastric cancer patients.
摘要：
可手术胃腺癌患者的护理标准是围手术期化疗和手术切除。缺陷错配修复（dMMR）/微卫星不稳定性（MSI-H）表型是晚期疾病中免疫检查点抑制剂（ICIs）功效的主要预测性生物标志物。几项II期和III期试验表明，在新辅助/辅助治疗中，有或没有化疗的免疫治疗未来有希望的作用。尤其是MSI-H局限性胃腺癌。我们介绍了一个在2022年3月诊断为低分化胃腺癌临床III期（cT4N0M0）的38岁男性，MLH1和PMS2缺乏，联合阳性评分（CPS）为100，HER2免疫组织化学阴性，对术前5-FU的肿瘤反应较差，亚叶酸,奥沙利铂,和多西他赛（FLOT）。由于结肠受累，它被认为是不可切除的，mesocolon,十二指肠,胰腺,和腹膜后.然后，5-FU一线全身治疗，亚叶酸,奥沙利铂（FOLFOX）-纳武单抗于2022年8月开始使用，六个周期后放射学肿瘤显着减少，允许在2023年3月进行治愈性手术，具有完全的病理肿瘤反应，随后卡培他滨和纳武单抗治疗一年，在2024年4月的最后一次随访中保持放射学缓解。有了这个病例报告,我们得出的结论是,对于MSI-H局部晚期胃癌患者,化学免疫疗法或单独免疫疗法可能是替代的新辅助治疗选择.
