A Case of Advanced Gastric Cancer with Peritoneal Metastasis Treated Successfully with Nivolumab

Abstract

Peritoneal metastasis (PM) is detected in 14% of gastric cancers at the time of initial diagnosis, with a median survival time of 4 months. A 66-year-old woman diagnosed with cT4a(SE) N2M1(LYN) cStage IV was treated with three lines of chemotherapy for a year. During the third line of chemotherapy, computed tomography (CT) scan revealed a large amount of ascites, periportal collar sign, and bilateral ureteral stenosis owing to PM. The tumor biomarkers (CEA and CA 19–9) remained elevated similar to the initial levels. The patient was administered 3 mg/kg nivolumab intravenously biweekly as the fourth line of chemotherapy. Three months after the nivolumab treatment, gastroscopy revealed an extreme reduction of the tumor size, while CT scan revealed the absence of ascites and a well-controlled tumor. There was no immune-related adverse event with nivolumab during and after the treatment, and performance status improved to 0. The patient has been alive for about 2.5 years since her first visit with her sixth line of chemotherapy (docetaxel). We report a case of advanced gastric cancer with PM that was treated successfully with nivolumab.

Clinical Impact of Prognostic Nutrition Index for Advanced Gastric Cancer Patients with Peritoneal Metastases Treated Nivolumab Monotherapy

“… 7 Notwithstanding, subgroup analyses of this data have shown disappointing results for peritoneal metastases, although there have been a few case reports of successful treatment when using nivolumab for AGC with peritoneal metastases. 8 Yet, the effects of ICIs seem to vary depending on the tumor biology, with various clinical factors also influencing the response to ICIs. 4 Thus, evaluating the clinical features and treatment outcomes for peritoneal metastases treated with nivolumab may help to provide more effective therapeutic strategies for AGC patients.…”