A 74-year-old man presented to our hospital because of
anorexia. Upper gastrointestinal endoscopy revealed type 3
gastric cancer. Further examination disclosed
metastasis to the perigastric lymph nodes and to the liver, and a diagnosis of non- resectable advanced
gastric cancer(cT4N2H1P0M0)in cStage Ⅳ was made. A total of 4 courses of S-1 plus
oxaliplatin therapy(80 mg/body/day and 100 mg/m2/cycle, respectively, for 2 weeks followed by a 1-week rest)were administered as the primary
chemotherapy. Then, another
metastasis to the abdominal lymph nodes and increased liver
metastasis were found; thus, the patient's condition was rated as progressive disease(PD). Secondary
chemotherapy comprising 10 courses of weekly
nab-paclitaxel(nab-PTX)plus
ramucirumab(RAM)
therapy(100 mg/m2 on days 1, 8, and 15 and 8 mg/kg on days 1 and 15, respectively, every 4 weeks)were administered. Although temporary reductions in the perigastric
lymph node metastasis and liver
metastasis as compared with the baseline were observed, another
metastasis to the abdominal lymph nodes occurred subsequently, resulting in PD. As tertiary
chemotherapy,
nivolumab therapy(240 mg/body, every 3 weeks) was repeated up to a total of 30 courses over 13 months. This
therapy was markedly effective, achieving a near complete response. The patient is currently being followed up as an outpatient.