Clinical and Experimental Gastroenterology (Jul 2023)

A Case of Pathologically Complete Response After Nivolumab Combined with Chemotherapy in a Gastric Cancer Patient with Virchow’s Lymph Node Metastasis

  • Izumo W,
  • Hosoda K,
  • Kuramochi H,
  • Nakajima G,
  • Maeda S,
  • Ito S,
  • Nagashima Y,
  • Itabashi M

Journal volume & issue
Vol. Volume 16
pp. 107 – 115

Abstract

Read online

Wataru Izumo,1 Kei Hosoda,1 Hidekazu Kuramochi,2 Go Nakajima,2 Shinsuke Maeda,1 Shunichi Ito,1 Yoji Nagashima,3 Michio Itabashi1 1Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, Tokyo, 162-8666, Japan; 2Department of Chemotherapy and Palliative Care, Tokyo Women’s Medical University, Tokyo, 162-8666, Japan; 3Department of Surgical Pathology, Tokyo Women’s Medical University Hospital, Tokyo, 162-8666, JapanCorrespondence: Wataru Izumo, Department of Surgery, Institute of Gastroenterology, Tokyo Women’s Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan, Tel +81-3-3353-8111, Fax +81-3-5269-7507, Email [email protected]: Gastric cancer with Virchow’s lymph node metastasis (LNM) is not indicated for initial curative surgery. Although there have been some case reports of curative resections after pre-operative treatment, including immune checkpoint inhibitors (ICIs), there is no consensus regarding the optimal timing of surgery. We describe a rare case of initially unresectable gastric cancer treated preoperatively with nivolumab combined chemotherapy, which achieved a pathologically complete response. An 82-year-old man was referred for gastric cancer treatment. Contrast-enhanced computed tomography revealed stomach wall thickening and swollen left supraclavicular LN. This gastric cancer was assessed as unresectable due to the presence of Virchow’s LNM; therefore, chemotherapy and ICI using S-1 plus oxaliplatin plus nivolumab were administered. After three courses of treatment, the primary tumor and Virchow’s LN showed a marked reduction in size. The patient underwent Virchow’s LNM resection as a preliminary step to determine indications for curative surgery. A pathological examination revealed no viable cancer cells were found inside the resected LN. The patient underwent distal gastrectomy. Pathological examination revealed complete degeneration of the primary tumor and regional LN without residual carcinoma. The patient did not receive adjuvant chemotherapy and survived with no evidence of recurrence for one year after the initial treatment.Keywords: gastric cancer, Virchow’s lymph metastasis, complete response, pre-operative treatment, nivolumab

Keywords