Complete remission of alpha-fetoprotein-producing gastric cancer by combined tislelizumab-apatinib treatment of a patient with proficient mismatch repair: a case report

Abstract

Background Alpha‑fetoprotein-producing gastric cancer (AFPGC) is a rare type of gastric cancer with a high rate of metastasis and poor prognosis. Despite substantial progress in the treatment of many solid tumors, there are no reports of the safety and effectiveness of immune checkpoint inhibitors in combination with antiangiogenesis agents for AFPGC patients who have proficient mismatch repair. Case presentation We describe a 69-year-old man who was diagnosed with metastatic AFPGC. After progression to chemotherapy resistance, tislelizumab combined with apatinib was administered, although the patient’s gastroscopic pathology showed proficient mismatch repair. After three cycles of therapy, partial remission (reduced by 56%) was obtained, and the quality of life improved significantly. Surprisingly, after more than 1 year of continuous application of the combination treatment regimen, both the primary and metastatic tumors in this patient eventually disappeared, which obtained complete remission without surgery. The patient has had a progression-free survival of more than 24 months and is still continuing to benefit. Conclusions This case is the first example of effective treatment of AFPGC with tislelizumab combined with apatinib. The outcomes of this case suggest a highly effective and tolerable therapeutic strategy for microsatellite-stabilized AFPGC.

An unusual cause of significantly elevated blood alpha-fetoprotein levels: a case report and literature review

“…Some patients can be alleviated completely and persistently by using the combination of a PD-1 inhibitor (tislelizumab) and an anti-angiogenic drug (apatinib) with light toxic effects. In addition, the primary tumor and metastatic lesions gradually shrinking, and eventually disappearing, resulting in good quality of life, and progression-free survival longer than 24 months ( 16 ).…”

“…Immune checkpoint inhibitors such as programmed cell death protein 1 (PD-1) and programmed cell death ligand 1 inhibitors have shown certain efficacy in the treatment of AFPGC (12,13). Vascular endothelial growth factor receptor is a target in AFPGC-targeted therapy research, and the targeted drugs primarily include apatinib and ramucirumab (14,15). Some patients can be alleviated completely and persistently by using the combination of a PD-1 inhibitor (tislelizumab) and an anti-angiogenic drug (apatinib) with light toxic effects.…”

Case report: Apatinib combined with neoadjuvant therapy for primary squamous cell carcinoma of the breast: a case report

“…Thus, neoadjuvant chemotherapy plus Apatinib is a novel choice for the treatment of PSCC. Recent studies have demonstrated the antitumor activity of apatinib in several solid tumors (Zhang et al, 2022b;Xiang et al, 2022;Zhu et al, 2022). Tumor angiogenesis plays an important role in tumor development and metastasis, and antiangiogenic drugs may improve the efficacy of conventional chemotherapy in the treatment of breast cancer (Liu et al, 2021;Lv et al, 2021).…”