Although a recent randomized clinical trial has demonstrated that the objective response rate to
nivolumab for metastatic
gastric cancer was 11.2%, there was no patients confirmed complete response. Herein, we report on a case of liver
metastasis arising from early
gastric cancer in which a complete clinical response was achieved to
nivolumab as third-line
therapy.
CASE PRESENTATION: A 77-year-old man was referred to Kochi Medical School Hospital for the treatment of liver
metastases from
gastric cancer. The patient had undergone laparoscopic total
gastrectomy with regional
lymph node dissection 30 months prior for early
gastric cancer, with a final diagnosis of T1N0M0, stage IA. The patient developed solitary splenic
metastasis measuring 42 mm 28 months later and underwent
splenectomy because there was no evidence of further metastatic lesions in any other organ. The patient was treated with S-1 plus
oxaliplatin based on negative immunohistochemical staining of the resected specimens for
human epidermal growth factor receptor 2 (HER2). Four months after the
splenectomy, the patient developed multiple liver
metastases and was treated with
ramucirumab plus
paclitaxel. Because of
disease progression, the patient was administered 3 mg/kg, i.v.,
nivolumab every 2 weeks. After 4 cycles of systemic treatment using
nivolumab, abdominal computed tomography revealed marked shrinkage of the liver
metastases. After 12 cycles of
nivolumab, the liver
metastases had disappeared completely. The patient did not develop any adverse reactions, including immune-reactive adverse events, during treatment. The patient continues to receive
nivolumab, and there is no evidence of disease recurrence in the 8-month period since starting
nivolumab.
CONCLUSIONS: To the best of our knowledge, this is the first case report in the English literature of a
gastric cancer patient achieving a complete clinical response to
nivolumab, and highlights the potential for successful treatment of metastatic
gastric cancer using
nivolumab.