A Case of Initially Unresectable Advanced Gastric Cancer with Curative Resection after Long-term Discontinuation of Nivolumab Therapy

• Published in: Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) Vol. 83; no. 8; pp. 1451 - 1457
• Main Authors: UEMATSU, Yosuke, SHIMIZU, Yoshimasa, KOGANEZAWA, Itsuki, TACHIKAWA, Nobuo, KOBAYASHI, Akihiko, SHATARI, Tomoo
• Format: Journal Article
• Language: Japanese
• Published: Japan Surgical Association 2022
• Subjects: conversion surgery; nivolumab; unresectable advanced gastric cancer
• ISSN: 1345-2843; 1882-5133
• DOI: 10.3919/jjsa.83.1451

A 66-year-old man was diagnosed with unresectable advanced gastric cancer (cT4bN3M1, cStage IVB) at presentation. After 12 courses of S-1 + oxaliplatin therapy and five courses of paclitaxel + ramucirumab therapy as second-line treatment, grade 3 peripheral neuropathy occurred ; thus, third-line treatment with nivolumab was initiated for 16 courses. By imaging studies, the primary lesion was remarkably reduced, and liver metastasis and peritoneal dissemination disappeared. Therefore, the therapeutic effect was judged as a partial response (PR). However, as PS had deteriorated, treatment continuation was deemed difficult. Upon re-evaluation 1 year after discontinuation of nivolumab, the PR was maintained, and staging laparoscopy was performed. In addition, conversion surgery was performed, as curative resection was possible. Total gastrectomy, splenectomy, D2 dissection, and Roux-en-Y reconstruction were performed, and the patient has survived for 15 months without recurrence. The effects of nivolumab on unresectable advanced gastric cancer may persist for a long time after treatment discontinuation. In cases of treatment interruption following the judgment of the therapeutic effect as PR, a continuous follow-up is important to not miss a chance for curative resection.