[A Case of Pathological Complete Response after Nivolumab Therapy in Unresectable Advanced Gastric Cancer].
R. OguraKazuhiro MigitaAtsujiro NishiokaYusuke KomedaTadashi NakagawaTakashi InoueYasuyuki NakataTakahiro YoshikawaNaoki KamitaniDaiki NezuHiromi KanaiTomohiro KuboMasaki MatsushitaHideki MatsuoKei MoriyaSaiho Ko
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Abstract:
A 70-year-old man was admitted to a local hospital with epigastric pain and diagnosed with type-2 gastric cancer. Contrast-enhanced CT scan showed metastases in S3 and S8 of the liver, and the tumor was classified as type cT4aN2H1, cStage ⅣB. Nivolumab monotherapy was initiated after failure of treatment with S-1 plus oxaliplatin and ramucirumab. After 6 courses, the primary tumor, lymph nodes, and liver metastases had shrunk to a remarkable degree. The patient underwent a proximal gastrectomy with D2 lymph node dissection and partial liver resection. Histopathological examination revealed no remaining tumor cells, with a histological response Grade 3.Keywords:
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症例は59歳，女性．T3 N3a M0 ER(－) PgR(－) HER2陽性．CEF100×4→DTX×4+トラスツズマブを施行後，理学所見・画像上腫瘍が消失したためBp+Axを施行し術後50Gyの照射を行った．切除標本において組織学的治療効果判定Grade 3，リンパ節転移も消失していた．しかし術後5カ月で局所に炎症性乳癌型再発をきたした．術前化学療法を行う上でpathological CR（pCR）は良好な予後を示すsurrogate markerとして有用である．一方，炎症性乳癌型再発は極めて予後不良とされている．しかし，術前化学療法～手術後の炎症性乳癌型再発に関してはまとまった報告はみられず，その発生頻度，予後など不明な点が多い．今回われわれは術前化学療法後pCRが得られたが，早期に炎症性再発をきたした症例を経験したので報告する．
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Background: The prognosis of rectal cancer has improved with neoadjuvant treatment for locally advanced disease. Twenty percent of patients respond to treatment with complete pathological regression, which is clinically estimated with magnetic resonance imaging. Aim: describe the properties of the pathological complete response group of patients at our institution Materials and methods: All selected patients received LCCRT at the University Hospital for Tumors Sestre milosrdnice University Hospital Center, Zagreb, between January 2014 and December 2019 and were later surgically treated at the same facility. Results: We identified 23 patients with complete pathological responses, of which, despite surgery, seven progressed. We recorded a higher proportion of female patients in that group and younger age of onset. MRI preoperatively was not yet predictive of a complete pathological response. Conclusion: The proportion of patients with a complete pathological response is 16% in this cohort. All patients underwent surgery but did not receive consolidating therapy. About 30% progressed during the observed period.
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In nivolumab therapy for unresectable advanced esophageal cancer, there are a few cases that show a complete response, and long-term survival can be expected in such cases. Here, we report a case in which nivolumab had a complete response to multiple lymph node metastases during multidisciplinary treatment for esophageal cancer and survived for a relatively long period despite being elderly. Examination of complete response cases provides us with significant insights in considering the unexplained biomarkers of immune checkpoint inhibitors and treatment discontinuation during complete response.
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Nivolumab plus ipilimumab represents an effective combination of checkpoint inhibitors that can lead to a durable response with minimal toxicity in patients with metastatic renal cell carcinoma (mRCC). We present a case of a pathologic complete response to neoadjuvant nivolumab plus ipilimumab in a patient with a 13.9 cm left renal mass and significant retroperitoneal and iliac lymphadenopathy, classified as intermediate-risk mRCC. We discuss and review the literature on complete responses after systemic therapy and the ability to predict who has undergone a complete response in the face of residual radiographic evidence of disease.
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This study was designed to examine the relationship between breast cancer molecular subtypes and pathological response to neoadjuvant chemotherapy (NAC) ± trastuzumab, in locally advanced breast cancer (LABC).Female patients with LABC (T2-T4, N0-N2, and M0) who received neoadjuvant chemotherapy + trastuzumab if HER2+ subtype, followed by surgery and radiotherapy ± hormonal therapy, were identified. The primary endpoint was pathologic complete response (pCR) in the breast and axilla (ypT0/ypN0), with final analysis on disease-free survival (DFS) and overall survival (OS).Six hundred eighty-one patients with a median age of 44 years, premenopausal: 70%, median tumour size: 7.0 cm (range 4-11 cm), stage II B: 27% and III A/III B: 73%, ER+/HER2-: 40.8%, ER-/HER2-: 23%, ER+/HER2+: 17.7%, and ER-/HER2+: 18.5%. Overall pCR (ypT0/ypN0) was 23%. The pCR rates based on molecular subtypes were ER+/HER2-: 9%; ER+/HER2+: 29%; ER-/HER2-: 31%; and ER-/HER2+: 37%. At median follow-up of 61 months, ER+/HER2+ and ER+/HER2- subtypes had the best 5-year DFS and OS; meanwhile, ER-/HER2+ and ER-/HER2- subtypes had the worst.Women with ER+/HER2- disease are the least likely to achieve pCR, with the highest rates in HER2+ and triple-negative subgroups. Degree of response is associated with OS; despite the comparatively higher likelihood of achieving pCR in ER-/HER2+ and triple-negative, these subgroups experience a survival detriment. We are consistent with the published data that patients who attain the pathological complete response defined as ypT0/ypN0 have improved outcomes.
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Abstract: Immune checkpoint inhibitors (ICI) as monotherapy in selected patients as well as in combination with chemotherapy have become the standard of care in the first-line treatment strategy of advanced non-small cell lung cancer (NSCLC) patients. Combination treatment with ICI, such as nivolumab and ipilimumab or durvaluamb and ipilimumab, has also been proposed as potential strategies in this setting in selected advanced NSCLC patients. Characterizing predictive markers of long-term clinical benefit with ICI is a critical objective. Tumor mutational burden has been proposed as a potential predictive biomarker. In this review, we discuss the efficacy of nivolumab and ipilimumab in advanced NSCLC patients as well as the clinical utility of tumor mutational burden in the efficacy of this combination. Ongoing clinical trials with nivolumab and ipilimumab, and the efficacy of this combination in subgroups of NSCLC patients, such as elderly patients and patients with brain metastases, are also discussed. Keywords: nivolumab, ipilimumab, tumor mutational burden, CheckMate trial, non-small cell lung cancer
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