Response to the rechallenge of combination immunotherapy in a patient with late-stage gastric cancer: case report.

Abstract

Until present, late-stage gastric cancer (GC) remains a refractory disease featured with poor prognosis. However, the upcoming era of immunotherapy turns situations around. Programmed death-1 receptor (PD-1)/programmed death-ligand 1 (PD-L1) signaling blockade, an option of immune checkpoint inhibitor (ICI), has gained approval for the third-line treatment of patients with locally advanced and/or metastatic GC. Despite its efficacy in a few tumor subtypes, most patients are insensitive to anti-PD-1 monotherapy. Therefore, growing interests arise in combination immunotherapy. To explore the maximal potentials of ICI, oncologists also focus on ICI rechallenge. Here we present a patient with unresected stage IV, Epstein-Barr virus (EBV) unrelated, microsatellite stable and HER2 heterogeneously expressed gastric adenocarcinoma who experienced the failures of previous immunotherapy. He was then rechallenged with identical ICI regime combined with tyrosine kinase inhibiting and anti-HER2 therapy. The patient responded and tolerated well to this regimen and survived with fair living quality after 28 months of treatment. This case suggests that patients who fail frontline immunotherapy still possibly benefit from rechallenge of the same anti-PD-1 regimen. Besides, combination of ICI and other target agents might intrigue a synergistic effect, resulting in enhanced anti-tumor effect, which provides a meaningful therapeutic strategy. Relevant studies are underway of investigation and might be a hotspot for future research.

• Authors: Zhening Zhang, Siyuan Cheng, Changsong Qi, Xiaotian Zhang, Zhi Peng, Lin Shen
• Journal: Annals of palliative medicine (Ann Palliat Med) Vol. 11 Issue 2 Pg. 818-826 (Feb 2022) ISSN: 2224-5839 [Electronic] China
• PMID: 34154337 (Publication Type: Case Reports)

Chemical References

• Immune Checkpoint Inhibitors

Topics

• Epstein-Barr Virus Infections (drug therapy)
• Herpesvirus 4, Human
• Humans
• Immune Checkpoint Inhibitors
• Immunotherapy (methods)
• Stomach Neoplasms (drug therapy)