晚期胃癌(AGC)患者预后较差,由于切除困难,可用的治疗选择有限。近年来,用于AGC的化疗和免疫治疗已显示出有希望的疗效.然而,对于经系统治疗的IV期胃癌患者,原发肿瘤和/或转移瘤的手术存在争议.这里,我们介绍了一名63岁的AGC退休女性,锁骨上转移,PD-L1阳性,肿瘤突变负担高(TMB-H).在接受8个周期的卡培他滨和奥沙利铂(XELOX)联合tislelizumab后,患者达到完全缓解(CR)。随访期间未发现复发的证据。据我们所知,这是首例伴有锁骨上转移的AGC患者,在使用tislelizumab治疗后达到CR.通过基因组和最近的临床研究讨论了CR的机制。结果表明,程序性死亡配体-1(PD-L1)联合阳性评分(CPS)≥5可作为化学免疫联合治疗的临床指征和标准。结合其他类似报告,微卫星不稳定性高/缺陷错配修复(MSI-H/dMMR)患者,(TMB-H),阳性PD-L1对tislelizumab的敏感性更好。患者在治疗过程中除出现消化道出血症状外,均顺利康复,这可能与治疗周期和年龄有关。tislelizumab的免疫治疗已经在恶性黑色素瘤的治疗中得到了很好的确立。肺癌,和肾透明细胞癌,但其对食管癌和胃癌的有效性和安全性仍有待验证。我们患者的CR表明tislelizumab在胃癌免疫治疗中的前景。此外,如果患者年龄较大或身体状况不佳,在免疫联合治疗后达到临床完全缓解(CCR)的AGC患者可以采用观察等待(WW)方法.
The prognosis for patients with advanced gastric cancer (AGC) is poor, with limited treatment options available due to the difficulty of resection. In recent years, chemotherapy and immunotherapy for AGC have shown promising efficacy. However, there is a controversy regarding the surgery of primary tumors and/or metastases in patients with stage IV gastric cancer after systematic therapy. Here, we present a 63-year-old retired female of AGC with supraclavicular metastasis with positive PD-L1 and tumor mutational burden-high (TMB-H). After receiving 8 cycles of capecitabine and oxaliplatin (XELOX) in combination with tislelizumab, the patient achieved complete remission (CR). No evidence of recurrence was identified during follow-up. To the best of our knowledge, this is the first
case of AGC with supraclavicular metastasis who achieved CR after treatment with tislelizumab. The mechanism of CR was discussed by genomic and recent clinical studies. The results indicated that programmed death ligand-1 (PD-L1) combined positive score (CPS) ≥5 may serve as a clinical indication and standard for chemo-immune combination therapy. In combination with other similar
reports, patients with microsatellite instability-high/defective mismatch repair (MSI-H/dMMR), (TMB-H), and positive PD-L1 had better sensitivity to tislelizumab. The patient recovered successfully except for symptoms of gastrointestinal hemorrhage during treatment, which may be associated with the treatment cycle and age. Immunotherapy with tislelizumab has been well-established in the treatment of malignant melanoma, lung cancer, and clear-cell kidney cancer, but its efficacy and safety for esophageal and gastric cancers remain to be validated. The CR of our patient suggested the prospects of tislelizumab in the immunotherapy of gastric cancer. Additionally, a watch-and-wait (WW) method maybe offered for patients with AGC who achieved complete clinical remission (CCR) after immune combination therapy if the patient was older or in poor physical condition.