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Case Reports
. 2020 Jul 24;9(4):193-198.
doi: 10.1007/s13691-020-00433-3. eCollection 2020 Oct.

A long-term survival case of unresectable gastric cancer with multidisciplinary therapy including immunotherapy and abscopal effect

Yuta Kuhara  1 , Motoki Ninomiya  2 , Satoshi Hirahara  1 , Hirofumi Doi  1 , Shirakawa Kenji  1 , Kazuhiro Toyota  1 , Raita Yano  1 , Hironori Kobayashi  1 , Yasushi Hashimoto  1 , Yujiro Yokoyama  1 , Yoshihiro Sakashita  1 , Katsunari Miyamoto  1
Affiliations
Case Reports

A long-term survival case of unresectable gastric cancer with multidisciplinary therapy including immunotherapy and abscopal effect

Yuta Kuhara et al. Int Cancer Conf J. .

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: Abscopal effect; Gastric cancer; Immunotherapy; Nivolumab; Pseudoprogression; Radiation therapy.

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Figures

Fig. 1
Fig. 1
Computed tomography scans of lesions before treatment. a Para-aortic lymph node swelling (arrow). b mediastinum lymph node swelling (arrow). c right iliac lymph node swelling (arrow). d Virchow lymph node swelling (arrow)
Fig. 2
Fig. 2
Overview of the clinical course of radiation therapy, surgery, chemotherapy, and immunotherapy improving performance status. Multidisciplinary therapy induced improvement of performance status and prolonged survival
Fig. 3
Fig. 3
Changes in the computed tomography images after first-line chemotherapy and second-line chemo-radiation therapy. a, b Distinct swelling of bilateral subclavian and mediastinal lymph nodes after six courses of SOX plus HER (arrow). c, d Bilateral subclavian and mediastinal lymph nodes reduced in size after three courses of RAM plus PTX and RT (arrow)
Fig. 4
Fig. 4
Changes of left axial lymph nodes and ascites induced by nivolumab. a, b Before administration of nivolumab. c, d Pseudoprogression after three courses of nivolumab. e Shrinkage after 12 courses. Arrows denote the different lymph nodes
Fig. 5
Fig. 5
Changes in left adrenal lesions. a After 12 courses of nivolumab (arrow). b After combination therapy with radiation
Fig. 6
Fig. 6
Changes in lesions as measured by 18F-fluorodeoxyglucose positron emission tomography. a Before treatment. b After 12 courses of nivolumab. c After 20 courses of nivolumab
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