Surgical treatment of metastatic brain tumor from gastric cancer during therapy with nivolumab: A case report

Abstract

Nivolumab is a new immunological checkpoint inhibitor that blocks the interaction of programmed cell death-1 (PD-1) with its ligand, programmed death-ligand 1 (PD-L1). The efficacy of nivolumab against brain metastases from gastric cancer has remained unclear. Here, we report a case of metastatic brain tumor from gastric cancer during therapy with nivolumab. A 70-year-old man with advanced gastric cancer treated with nivolumab as 4th-line chemotherapy experienced nausea and dizziness. Magnetic resonance imaging demonstrated a 3-cm, enhancing lesion in the right cerebellar hemisphere on contrast-enhanced T1-weighted imaging. The patient underwent surgical resection of the tumor. The specimen was pathologically diagnosed as metastasis from the gastric cancer, and was immunohistochemically negative for PD-L1 and PD-1, suggesting a lack of sensitivity to nivolumab. Postoperatively, symptoms gradually improved and he could be discharged to home 3 days after surgery. If brain metastases from gastric cancer are identified as not sensitive to nivolumab therapy and are exerting mass effects, surgical resection should be selected in patients with good Karnofsky performance status.

Keywords

• Metastatic brain tumor
• Gastric cancer
• Nivolumab
• Immunological checkpoint inhibitor
• Neurosurgery