Pathological Complete Response in a Patient With HER2-Negative Esophagogastric Junction Cancer Undergoing Conversion-Intent Surgery After Ramucirumab Plus Paclitaxel Following Nivolumab-Based Chemotherapy: A Case Report.
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引用次数: 0
Abstract
Background: Nivolumab and other immune checkpoint inhibitors (ICIs) have improved survival in advanced gastric cancer. However, optimal management after progression on ICI-containing therapy remains uncertain. We report a case of HER2-negative esophagogastric junction (EGJ) cancer that showed a marked radiological and metabolic response to second-line ramucirumab plus paclitaxel (RAM + PTX) after nivolumab-based chemotherapy, allowing conversion-intent surgery, after which pathological complete response (pCR) was confirmed in the resected specimen.
Case presentation: A 76-year-old woman was diagnosed with advanced HER2-negative EGJ adenocarcinoma with para-aortic lymph node metastases (cT3N3bM1[Lym], Stage IVB according to the 15th edition of the Japanese Classification of Gastric Carcinoma). The tumor was classified as Siewert type III with minimal esophageal invasion. First-line SOX plus nivolumab was administered, but disease progression with mediastinal lymph node enlargement and suspected pulmonary metastases was observed after five cycles. Second-line RAM + PTX was subsequently initiated and resulted in marked regression of the primary tumor and metastatic lesions on computed tomography and endoscopy, with metabolic complete response on positron emission tomography-computed tomography. Although chemotherapy was temporarily interrupted because of immune-related type 1 diabetes mellitus, metabolic complete response was maintained after glycemic control with insulin therapy. Following multidisciplinary evaluation of treatment response and resectability, robot-assisted proximal gastrectomy with D2 lymphadenectomy and double-flap reconstruction was performed. Histopathological examination demonstrated no residual viable tumor cells (ypT0N0), consistent with pCR. The postoperative course was uneventful, and the patient remains clinically recurrence-free 10 months after surgery.
Conclusions: This case suggests that RAM + PTX after nivolumab-based chemotherapy may achieve substantial tumor regression in selected patients with advanced EGJ cancer and may provide an opportunity for conversion surgery. Robot-assisted proximal gastrectomy with double-flap reconstruction was feasible after successful systemic therapy. Careful multidisciplinary assessment and accumulation of further clinical evidence are needed to clarify the role of sequential systemic therapy and surgical intervention in this setting.
期刊介绍：
The Journal of Gastrointestinal Cancer is a multidisciplinary medium for the publication of novel research pertaining to cancers arising from the gastrointestinal tract.The journal is dedicated to the most rapid publication possible.The journal publishes papers in all relevant fields, emphasizing those studies that are helpful in understanding and treating cancers affecting the esophagus, stomach, liver, gallbladder and biliary tree, pancreas, small bowel, large bowel, rectum, and anus. In addition, the Journal of Gastrointestinal Cancer publishes basic and translational scientific information from studies providing insight into the etiology and progression of cancers affecting these organs. New insights are provided from diverse areas of research such as studies exploring pre-neoplastic states, risk factors, epidemiology, genetics, preclinical therapeutics, surgery, radiation therapy, novel medical therapeutics, clinical trials, and outcome studies.In addition to reports of original clinical and experimental studies, the journal also publishes: case reports, state-of-the-art reviews on topics of immediate interest or importance; invited articles analyzing particular areas of pancreatic research and knowledge; perspectives in which critical evaluation and conflicting opinions about current topics may be expressed; meeting highlights that summarize important points presented at recent meetings; abstracts of symposia and conferences; book reviews; hypotheses; Letters to the Editors; and other items of special interest, including:Complex Cases in GI Oncology: This is a new initiative to provide a forum to review and discuss the history and management of complex and involved gastrointestinal oncology cases. The format will be similar to a teaching case conference where a case vignette is presented and is followed by a series of questions and discussion points. A brief reference list supporting the points made in discussion would be expected.
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