A long-term survival case of unresectable gastric cancer with multidisciplinary therapy including immunotherapy and absc
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CASE REPORT
A long‑term survival case of unresectable gastric cancer with multidisciplinary therapy including immunotherapy and abscopal effect Yuta Kuhara1 · Motoki Ninomiya2 · Satoshi Hirahara1 · Hirofumi Doi1 · Shirakawa Kenji1 · Kazuhiro Toyota1 · Raita Yano1 · Hironori Kobayashi1 · Yasushi Hashimoto1 · Yujiro Yokoyama1 · Yoshihiro Sakashita1 · Katsunari Miyamoto1 Received: 19 April 2020 / Accepted: 13 July 2020 © The Japan Society of Clinical Oncology 2020
Abstract The prognosis of unresectable gastric cancer remains poor. Multidisciplinary treatment of unresectable gastric cancer is, therefore, thought to be essential for improving patients’ outcomes. Here, we report a successful case of multidisciplinary therapy for unresectable gastric cancer. The patient was a 69-year-old woman who was diagnosed with type 2 gastric cancer with remote lymph node metastases and peritoneal dissemination. Although shrinkage of the primary lesion and remote lymph nodes were observed following chemotherapy, we performed distal gastrectomy to deal with continuous bleeding from the primary lesion. Combination therapy with radiation and chemotherapy was effective for multiple metastases in both subclavian lymph nodes and metachronous multiple axillary lymph nodes. Nivolumab combined with radiation therapy also induced regression of remote lymph node metastases, peritoneal dissemination, and adrenal metastasis. Abscopal effects, i.e., shrinkage of the non-irradiated lesions, were also observed. Thus far, the patient has been able to maintain a good quality of life while receiving continued nivolumab therapy. Multidisciplinary therapy including immunotherapy and abscopal effect may improve the quality of life and contribute to long-term survival of patients with unresectable gastric cancer. Keywords Gastric cancer · Nivolumab · Immunotherapy · Radiation therapy · Abscopal effect · Pseudoprogression
Introduction Gastric cancer is one of the most lethal cancers worldwide, and prognosis of patients with unresectable gastric cancer (UGC) remains poor despite recent advances in the treatment of this disease [1, 2]. Immune checkpoint inhibitors targeting the programmed death-ligand 1 have been used to treat various types of cancer such as melanoma and lung carcinomas [3, 4]. For example, nivolumab, which was shown to exhibit a survival benefit in patients with advanced gastric cancer in the ATT * Yuta Kuhara [email protected] 1
Department of Surgery, Hiroshima Memorial Hospital, 1‑4‑3, Honkawatyo, Nakaku, Hiroshima, Hiroshimashi, Japan
Digestive Disease Center, Hiroshima Memorial Hospital, Hiroshima, Japan
2
RACTION-2 trial, has been approved for late-line treatment of advanced and recurrent gastric cancer [5]. Alternatively, radiation therapy (RT) has been used to palliate intractable symptoms such as pain associated with bone or spinal cord metastases, or anemia due to gastric bleeding [6]. Furthermore, RT may exhibit systemic abscopal effects, i.e., regression of non-irradiated lesions besides its localized tumo
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