Successful Conversion Surgery Following Bullous Pemphigoid after Nivolumab for Advanced Gastric Cancer

412 Background: Conversion surgery for unresectable advanced gastric cancer has been increasing with the development of chemotherapy. Adjuvant chemotherapy regimens after conversion surgery have not been standardized. The main mechanism of nivolumab is augmentation of antitumor immune response of tumor infiltrating cytotoxic T cells (CTL) to cancer cells, and it has recently been reported that nivolumab therapy before and after chemotherapy is effective in other carcinomas. We previously reported that tertiary lymphoid architecture (TLS) correlates with tumor-infiltrating T cells and is associated with a better prognosis in untreated patients. The purpose of this study was to investigate the relationship between the presence of TLS in the primary tumor and prognosis in patients with gastric cancer who underwent conversion therapy. Methods: We evaluated 52 patients with advanced gastric cancer including 17 patients underwent conversion surgery and 35 patients underwent palliative surgery without prior chemotherapy in our department from 2009 to 2017. The local immune environment and presence of TLS was evaluated by immunohistochemical staining. Results: Intratumoral TLS occurred in 20% of patients with advanced cancer who did not receive chemotherapy before surgery and in 52% of patients who received conversion surgery. And the prognosis of patients with the presence of TLS was better than no TLS. Intratumoral CD8 T-cell infiltration was slightly associated presence of TLS. We had a case in which nivolumab was highly effective and converted to conversion surgery, and a case in which nivolumab was highly effective in patients with recurrence after conversion surgery. TLS was observed in the vicinity of the tumor in these patients. Conclusions: The prognosis was good in the case in which intratumoral TLS was present after conversion surgery. These results suggest that the adjuvant nivolumab therapy may improve the outcome of patients underwent conversion surgery for advanced gastric cancer. These results suggest that peri-tumor TLS is a predictor of nivolumab efficacy in adjuvant therapy after conversion surgery.

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Successful Conversion Surgery Following Chylous Ascites After Nivolumab for Advanced Gastric Cancer

In Vivo ◽

10.21873/invivo.11810 ◽

2020 ◽

Vol 34 (2) ◽

pp. 583-585 ◽

Cited By ~ 1

Author(s):

SATOSHI TOYOTA ◽

HIROYUKI ORITA ◽

YASURO FUKUYAMA ◽

SAKI MOTOYOSHI ◽

SHOGO KAWANAMI ◽

...

Keyword(s):

Gastric Cancer ◽

Advanced Gastric Cancer ◽

Chylous Ascites ◽

Conversion Surgery

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Conversion Surgery for Patients With Stage IV HER2-Positive Gastric Cancer: A Report of 3 Patients

International Surgery ◽

10.9738/intsurg-d-16-00184.1 ◽

2017 ◽

Vol 102 (3-4) ◽

pp. 137-140 ◽

Cited By ~ 1

Author(s):

Shin Saito ◽

Yoshinori Hosoya ◽

Hirofumi Fujii ◽

Hideyuki Ohzawa ◽

Akira Tanaka ◽

...

Keyword(s):

Gastric Cancer ◽

Targeted Therapy ◽

Advanced Gastric Cancer ◽

Molecular Targeted Therapy ◽

Stage Iv ◽

Complete Response ◽

Conversion Surgery ◽

Her2 Positive ◽

Stage Iv Gastric Cancer ◽

Metastatic Lesions

Gastric cancer is a common malignancy and remains potentially lethal. The prognosis of patients with stage IV gastric cancer is thought to be poor, but new molecular targeted therapy may benefit patients with advanced gastric cancer. Currently, conversion surgery after chemotherapy with a trastuzumab-containing regimen is reported to be effective in these patients. We present 3 patients with human epidermal growth factor receptor 2 (HER2)–positive advanced gastric cancer who underwent conversion surgery after receiving a trastuzumab-containing chemotherapy regimen. Interestingly, the primary lesion acquired resistance to the trastuzumab-containing regimen, although the metastatic lesions maintained a complete response. The reason why the primary lesions became resistant to trastuzumab remains unclear. More studies are needed to clarify the mechanism of resistance. Conversion surgery, made possible by the use of molecular-targeted therapy, may improve the prognosis of patients with stage IV gastric cancer, particularly if metastatic lesions show a complete response to therapy.

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