内容紹介
Summary
A 66—year—old man was diagnosed with advanced gastric cancer(L, Less, Type 2, T4a[SE], N2, M1[LYM], H0, P0, cStage Ⅳ)and received treatment with S—1/cisplatin as first—line chemotherapy. This treatment resulted in partial response(PR)after 3 months, with reduction in the sizes of metastatic lymph nodes surrounding the pancreatic head and paraaortic lesion. However, the sizes of metastatic lymph nodes increased after 7 months of chemotherapy. Ramucirumab/nab—paclitaxel was then administered as second—line chemotherapy, and the diameter of the metastatic lymph nodes subsequently decreased after 4 months of the regimen. However, progressive disease was observed at 7 months, and blood transfusion was required because of bleeding from the primary gastric tumor. Therefore, nivolumab was initiated as third—line chemotherapy 14 months after the first treatment. After nivolumab administration, a 28% reduction in metastatic lymph nodes was achieved within 3 months, together with the regression of the primary gastric tumor and improvement in anemia within 6 months. PR was achieved after 12 months of nivolumab administration, and effective disease control was maintained for 16 months without any adverse reaction to nivolumab.
要旨
症例は66歳,男性。進行胃癌,L,Less,Type 2,T4a(SE),N2,M1(LYM),H0,P0,cStage Ⅳの診断で,S—1+シスプラチン併用療法(SP療法)を開始した。SP療法3か月目で転移リンパ節の縮小を認めpartial response(PR)となったが,7か月目でprogressive disease(PD)となり,二次治療としてラムシルマブ+ナブパクリタキセル併用療法に変更した。SP療法開始後,転移リンパ節の縮小を認めたが,SP療法7か月目でPDとなった。上部消化管内視鏡検査では胃原発巣の縮小はなく,輸血を要する腫瘍出血を認めた。一次治療開始から14か月目で三次治療としてニボルマブ療法に変更したところ,SP治療3か月で転移リンパ節の28%の縮小を認め,6か月目には原発巣も縮小し貧血コントロールが可能となった。その後もニボルマブによる副作用は認めず投与継続が可能であり,SP治療12か月目にはPRとなり,16か月目まで病勢のコントロールが可能であった。
目次
A 66—year—old man was diagnosed with advanced gastric cancer(L, Less, Type 2, T4a[SE], N2, M1[LYM], H0, P0, cStage Ⅳ)and received treatment with S—1/cisplatin as first—line chemotherapy. This treatment resulted in partial response(PR)after 3 months, with reduction in the sizes of metastatic lymph nodes surrounding the pancreatic head and paraaortic lesion. However, the sizes of metastatic lymph nodes increased after 7 months of chemotherapy. Ramucirumab/nab—paclitaxel was then administered as second—line chemotherapy, and the diameter of the metastatic lymph nodes subsequently decreased after 4 months of the regimen. However, progressive disease was observed at 7 months, and blood transfusion was required because of bleeding from the primary gastric tumor. Therefore, nivolumab was initiated as third—line chemotherapy 14 months after the first treatment. After nivolumab administration, a 28% reduction in metastatic lymph nodes was achieved within 3 months, together with the regression of the primary gastric tumor and improvement in anemia within 6 months. PR was achieved after 12 months of nivolumab administration, and effective disease control was maintained for 16 months without any adverse reaction to nivolumab.
要旨
症例は66歳,男性。進行胃癌,L,Less,Type 2,T4a(SE),N2,M1(LYM),H0,P0,cStage Ⅳの診断で,S—1+シスプラチン併用療法(SP療法)を開始した。SP療法3か月目で転移リンパ節の縮小を認めpartial response(PR)となったが,7か月目でprogressive disease(PD)となり,二次治療としてラムシルマブ+ナブパクリタキセル併用療法に変更した。SP療法開始後,転移リンパ節の縮小を認めたが,SP療法7か月目でPDとなった。上部消化管内視鏡検査では胃原発巣の縮小はなく,輸血を要する腫瘍出血を認めた。一次治療開始から14か月目で三次治療としてニボルマブ療法に変更したところ,SP治療3か月で転移リンパ節の28%の縮小を認め,6か月目には原発巣も縮小し貧血コントロールが可能となった。その後もニボルマブによる副作用は認めず投与継続が可能であり,SP治療12か月目にはPRとなり,16か月目まで病勢のコントロールが可能であった。