Locally advanced gastric cancer (GC) is often managed by neoadjuvant chemotherapy and surgery; however, pathological complete responses to preoperative systemic treatment are rare. Some GCs are characterised by high-level microsatellite instability (MSI-H) and therefore are potentially sensitive to anti-PD1 (the programmed death 1) therapy. Neoadjuvant immune checkpoint blockade demonstrated promising results in a number of trials involving various categories of patients with cancer; therefore, we considered feasible to offer preoperative nivolumab to a patient with T3N1M0 MSI-H GC. The patient experienced a reduction of the tumour size and the analysis of surgical material revealed complete elimination of tumour cells. MSI-H status deserves to be considered in future trials on patients with GC.
- gastric cancer
- gastrointestinal system
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Contributors Due to the rapid progression of locally advanced gastric cancer after perioperative chemotherapy in routine clinical practice, our Center attempts to individualise treatment based on predictive biomarkers. After presenting a patient with MSI-H gastric cancer at MTD by the medical oncologist GI and conducting a scientific discussion with the Head of the Cancer Center VM, Head of the genetic laboratory EI, Head of the CT Department VC, an attempt was made to individualise the immunotherapy of the patient taking into account genetic disorders. This strategy was based on the clinical experience of the Head of the Cancer Center VM and the Head of the CT Department VC, which included achieving an extremely high objective response of the MSI-H disseminated tumours of the various locations. Medical oncologist GI carried out the immunotherapy for the patient in the CT Department under the guidance of VC. Consultations in the scientific group, which included all authors, as well as employees of the Department of endoscopy, radiology and abdominal surgeons, were performed at each cycle of immunotherapy. Our team has not found similar studies in locally advanced gastric cancer, taking into account the molecular marker, in the literature. Therefore, taking into account the positive effect of this treatment with CPI and the absence of the toxicity, VC prepared the manuscript draft with important intellectual input from EI and VM. All authors approved the final manuscript.
Funding This work is supported by the Russian Science Foundation (grant 17-75-30027).
Competing interests None declared.
Patient consent for publication Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.