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CASE REPORT article
Front. Oncol.
Sec. Gastrointestinal Cancers: Gastric and Esophageal Cancers
Volume 14 - 2024 |
doi: 10.3389/fonc.2024.1440046
Complete response of a metastatic microsatellite-stable gastric cancer after neoadjuvant chemo-immunotherapy: should we still operate? A case-report and review of the literature
Provisionally accepted- University Hospitals of Geneva, Geneva, Switzerland
Gastric cancer often presents at an advanced stage in Western populations due to the lack of screening programs, leading to poor prognoses. Historically, palliative chemotherapy resulted in a median survival of 9.9 months. However, the introduction of the FLOT regimen and immunotherapy has significantly altered treatment outcomes. Oligometastatic gastric cancer, defined as metastasis limited to a single organ or few sites, has emerged as a distinct subgroup with improved survival when treated with a combination of systemic and local therapies. We present the case of a 54-year-old male diagnosed with microsatellite stable (MSS) oligometastatic gastric adenocarcinoma, including liver and peritoneal metastases, who achieved a complete pathological response following neoadjuvant chemo-immunotherapy with FOLFOX and nivolumab. Despite unfavorable prognostic factors, such as liver involvement and positive peritoneal cytology, the patient responded well to treatment, allowing curative surgery. Post-operative histology confirmed complete regression of both the primary tumor and metastases, with no recurrence observed at the one-year follow-up. This case shows the potential of combined chemo-immunotherapy to convert previously inoperable MSS gastric cancer to surgical candidates. Further research is needed to better define patient selection criteria and assess long-term outcomes for these patients.
Keywords: Pathological complete response ( PCR ), gastric cancer, Oligometastatic, exceptional responders, Conversion surgery, Immunotherapy
Received: 28 May 2024; Accepted: 16 Oct 2024.
Copyright: © 2024 Mechahougui, Chevallay, Cauchy, Chaveau, Puppa, Koessler and Monig. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Mickael Chevallay, University Hospitals of Geneva, Geneva, Switzerland
Francois Cauchy, University Hospitals of Geneva, Geneva, Switzerland
Nicolas Chaveau, University Hospitals of Geneva, Geneva, Switzerland
Thibaud Koessler, University Hospitals of Geneva, Geneva, Switzerland
Stefan Monig, University Hospitals of Geneva, Geneva, Switzerland
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