根治術でNivolumabによる病理学的完全奏効が確認された高度進行胃癌の1例
症例は71歳，男性．前医でHb 6.9mg/dlの貧血を指摘され，当院を受診した．CT・上部消化管内視鏡検査で胃前庭部に肝浸潤を伴った3型腫瘍を認め，cT4b（HEP）N0M0，cStage IVAの高度進行胃癌と診断した．化学療法を行う方針とし，一次治療でFOLFOX療法を6コース施行し，二次治療でramucirumab+nab-PTX療法を7コース施行したが，治療効果は進行（progressive disease : PD）だった．三次治療でnivolumab を11コース投与したところ，局所の腫瘍と肝浸潤が著明に縮小し，生検結果でも腫瘍細胞を指摘されなかった．根治術可能であると判断し，初...
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| Published in | 日本臨床外科学会雑誌 Vol. 84; no. 11; pp. 1743 - 1749 |
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| Main Authors | , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本臨床外科学会
2023
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1345-2843 1882-5133 |
| DOI | 10.3919/jjsa.84.1743 |
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| Abstract | 症例は71歳，男性．前医でHb 6.9mg/dlの貧血を指摘され，当院を受診した．CT・上部消化管内視鏡検査で胃前庭部に肝浸潤を伴った3型腫瘍を認め，cT4b（HEP）N0M0，cStage IVAの高度進行胃癌と診断した．化学療法を行う方針とし，一次治療でFOLFOX療法を6コース施行し，二次治療でramucirumab+nab-PTX療法を7コース施行したが，治療効果は進行（progressive disease : PD）だった．三次治療でnivolumab を11コース投与したところ，局所の腫瘍と肝浸潤が著明に縮小し，生検結果でも腫瘍細胞を指摘されなかった．根治術可能であると判断し，初診から20カ月目に手術を施行した．最終病理組織診でも腫瘍細胞を指摘されず，病理学的完全奏効（pathological complete response : pCR）と判断した．本症例は術後14カ月経過した現在も再発なく経過しており，非常に有用な経過を辿った1例として，文献的考察を加えて報告する． |
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| AbstractList | 症例は71歳，男性．前医でHb 6.9mg/dlの貧血を指摘され，当院を受診した．CT・上部消化管内視鏡検査で胃前庭部に肝浸潤を伴った3型腫瘍を認め，cT4b（HEP）N0M0，cStage IVAの高度進行胃癌と診断した．化学療法を行う方針とし，一次治療でFOLFOX療法を6コース施行し，二次治療でramucirumab+nab-PTX療法を7コース施行したが，治療効果は進行（progressive disease : PD）だった．三次治療でnivolumab を11コース投与したところ，局所の腫瘍と肝浸潤が著明に縮小し，生検結果でも腫瘍細胞を指摘されなかった．根治術可能であると判断し，初診から20カ月目に手術を施行した．最終病理組織診でも腫瘍細胞を指摘されず，病理学的完全奏効（pathological complete response : pCR）と判断した．本症例は術後14カ月経過した現在も再発なく経過しており，非常に有用な経過を辿った1例として，文献的考察を加えて報告する． |
| Author | 伊吹, 省 熊谷, 知子 櫻井, 嘉彦 茂垣, 雅俊 中山, 祐次郎 |
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| References | 20) Namikawa T, Ishida N, Tsuda S, et al : Successful treatment of liver metastases arising from early gastric cancer achieved clinical complete response by nivolumab. Surg Case Rep 2018 ; 4 : 71 4) Janjigian YY, Shitara K, Moehler M, et al : First-line nivolumab plus chemotherapy versus chemotherapy alone for advanced gastric, gastro-oesophageal junction, and oesophageal adenocarcinoma (CheckMate 649) : a randomised, open-label, phase 3 trial. Lancet 2021 ; 398 : 27-40 19) Takami T, Yasuda K, Uozumi N, et al : Confirmed complete response to nivolumab for advanced gastric cancer with peritoneal dissemination : a case report. J Med Case Rep 2021 ; 15 : 604 6) 小野薬品工業:オプジーボ適正使用ガイド，（Accessed Mar. 25, 2022, at https://www.opdivo.jp/system/files?file=2022-02/OPD_guide_combi.pdf） 1) 日本胃癌学会/編:胃癌治療ガイドライン医師用2021年7月改訂第6版．金原出版，東京，2021，p30-37 11) 白石 匡，加野将之，坂田治人他:Nivolumabによる治療後にConversion Surgeryを施行し得た胃癌の1例．癌と化療 2019;46:1614-1616 14) 前田詠理，秋田真之，西村 透他:ニボルマブ投与中に水疱性類天疱瘡を生じたがconversion surgeryを施行しえた進行胃癌の1例．日消外会誌 2021;54:802-812 17) 花香淳一，橋本真治，高橋真治他:Nivolumabが著効した切除不能進行胃癌の1例．癌と化療 2021;48:1165-1167 15) Doi H, Ninomiya M, Toyota K, et al : A case of multiple metastatic gastric cancer with primary lesion vanished after administrating nivolumab, and the effect remains even after discontinuance of therapy. Int Cancer Conf J 2020 ; 9 : 187-192 5) Kang YK, Chen LT, Ryu MH, et al : Nivolumab plus chemotherapy versus placebo plus chemotherapy in patients with HER2-negative, untreated, unresectable advanced or recurrent gastric or gastro-oesophageal junction cancer (ATTRACTION-4) : a randomised, multicentre, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol 2022 ; 23 : 234-247 12) 大野達矢，宇野秀彦，高原善博他:Conversion Surgeryにより根治切除し得た切除不能進行胃癌の1例．癌と化療 2020;47:2254-2256 23) Yoshida K, Yasufuku I, Terashima M, et al : International Retrospective Cohort Study of Conversion Therapy for Stage IV Gastric Cancer 1 (CONVO-GC-1). Ann Gastroenterol Surg 2021 ; 6 : 227-240 22) Fujitani K, Yang HK, Mizusawa J, et al : Gastrectomy plus chemotherapy versus chemotherapy alone for advanced gastric cancer with a single non-curable factor (REGATTA) : a phase 3, randomised controlled trial. Lancet Oncol 2016 ; 17 : 309-318 3) Kang YK, Boku N, Satoh T, et al : Nivolumab in patients with advanced gastric or gastro-oesophageal junction cancer refractory to, or intolerant of, at least two previous chemotherapy regimens (ONO-4538-12, ATTRACTION-2) : a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 2017 ; 390 : 2461-2471 13) Toyota Y, Okamoto K, Tanaka N, et al : Conversion surgery of Stage IV gastric cancer with peritoneal dissemination after nivolumab. Int Cancer Conf J 2021 ; 10 : 280-284 9) Matsumoto R, Arigami T, Matsushita D, et al : Conversion surgery for stage IV gastric cancer with a complete pathological response to Nivolumab : a case report. World J Surg Oncol 2020 ; 18 : 179 18) Tirino G, Petrillo A, Pompella L, et al : Durable Complete Radiological Response to Nivolumab in Two Heavily Pretreated Western Elderly Patients With Metastatic Gastric Cancer : A Case Report. Front Oncol 2020 ; 10 : 130 7) 畑中一映，早坂秀平，土田直央他:Nivolumabが著効しConversion Surgeryを施行後完全奏効が確認された胃癌の1例．道南医会ジャーナル 2020;3:18-22 16) Komo T, Suzuki T, Tazawa H, et al : Clinical complete response after nivolumab administered as a third-line treatment for unresectable advanced gastric cancer with peritoneal dissemination : A case report. Int J Surg Case Rep 2021 ; 84 : 106161 2) 日本胃癌学会/編:胃癌取扱い規約第15版．金原出版，東京，2017，p2-26 8) 小泉範明，柏木里織，荻野真平他:Nivolumab療法によりConversion Surgeryが可能となった進行胃癌の1例．癌と化療 2020;47:1621-1623 10) Chubenko V, Inusilaev G, Imyanitov E, et al : Clinical case of the neoadjuvant treatment with Nivolumab in a patient with microsatellite unstable (MSI-H) locally advanced gastric cancer. BMJ Case Rep 2020 ; 13 : e236144 21) 澤崎美幸，芝 俊成，早川勇二他:S-1，オキサリプラチン，ナブパクリタキセルの3剤併用化学療法にイトラコナゾールを併用しconversion surgeryを施行できた切除不能胃癌の1例．日消誌 2022;119:153-161 |
| References_xml | – reference: 19) Takami T, Yasuda K, Uozumi N, et al : Confirmed complete response to nivolumab for advanced gastric cancer with peritoneal dissemination : a case report. J Med Case Rep 2021 ; 15 : 604 – reference: 3) Kang YK, Boku N, Satoh T, et al : Nivolumab in patients with advanced gastric or gastro-oesophageal junction cancer refractory to, or intolerant of, at least two previous chemotherapy regimens (ONO-4538-12, ATTRACTION-2) : a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 2017 ; 390 : 2461-2471 – reference: 18) Tirino G, Petrillo A, Pompella L, et al : Durable Complete Radiological Response to Nivolumab in Two Heavily Pretreated Western Elderly Patients With Metastatic Gastric Cancer : A Case Report. Front Oncol 2020 ; 10 : 130 – reference: 9) Matsumoto R, Arigami T, Matsushita D, et al : Conversion surgery for stage IV gastric cancer with a complete pathological response to Nivolumab : a case report. World J Surg Oncol 2020 ; 18 : 179 – reference: 12) 大野達矢，宇野秀彦，高原善博他:Conversion Surgeryにより根治切除し得た切除不能進行胃癌の1例．癌と化療 2020;47:2254-2256 – reference: 11) 白石 匡，加野将之，坂田治人他:Nivolumabによる治療後にConversion Surgeryを施行し得た胃癌の1例．癌と化療 2019;46:1614-1616 – reference: 14) 前田詠理，秋田真之，西村 透他:ニボルマブ投与中に水疱性類天疱瘡を生じたがconversion surgeryを施行しえた進行胃癌の1例．日消外会誌 2021;54:802-812 – reference: 8) 小泉範明，柏木里織，荻野真平他:Nivolumab療法によりConversion Surgeryが可能となった進行胃癌の1例．癌と化療 2020;47:1621-1623 – reference: 17) 花香淳一，橋本真治，高橋真治他:Nivolumabが著効した切除不能進行胃癌の1例．癌と化療 2021;48:1165-1167 – reference: 22) Fujitani K, Yang HK, Mizusawa J, et al : Gastrectomy plus chemotherapy versus chemotherapy alone for advanced gastric cancer with a single non-curable factor (REGATTA) : a phase 3, randomised controlled trial. Lancet Oncol 2016 ; 17 : 309-318 – reference: 7) 畑中一映，早坂秀平，土田直央他:Nivolumabが著効しConversion Surgeryを施行後完全奏効が確認された胃癌の1例．道南医会ジャーナル 2020;3:18-22 – reference: 16) Komo T, Suzuki T, Tazawa H, et al : Clinical complete response after nivolumab administered as a third-line treatment for unresectable advanced gastric cancer with peritoneal dissemination : A case report. Int J Surg Case Rep 2021 ; 84 : 106161 – reference: 2) 日本胃癌学会/編:胃癌取扱い規約第15版．金原出版，東京，2017，p2-26 – reference: 15) Doi H, Ninomiya M, Toyota K, et al : A case of multiple metastatic gastric cancer with primary lesion vanished after administrating nivolumab, and the effect remains even after discontinuance of therapy. Int Cancer Conf J 2020 ; 9 : 187-192 – reference: 6) 小野薬品工業:オプジーボ適正使用ガイド，（Accessed Mar. 25, 2022, at https://www.opdivo.jp/system/files?file=2022-02/OPD_guide_combi.pdf） – reference: 4) Janjigian YY, Shitara K, Moehler M, et al : First-line nivolumab plus chemotherapy versus chemotherapy alone for advanced gastric, gastro-oesophageal junction, and oesophageal adenocarcinoma (CheckMate 649) : a randomised, open-label, phase 3 trial. Lancet 2021 ; 398 : 27-40 – reference: 21) 澤崎美幸，芝 俊成，早川勇二他:S-1，オキサリプラチン，ナブパクリタキセルの3剤併用化学療法にイトラコナゾールを併用しconversion surgeryを施行できた切除不能胃癌の1例．日消誌 2022;119:153-161 – reference: 1) 日本胃癌学会/編:胃癌治療ガイドライン医師用2021年7月改訂第6版．金原出版，東京，2021，p30-37 – reference: 20) Namikawa T, Ishida N, Tsuda S, et al : Successful treatment of liver metastases arising from early gastric cancer achieved clinical complete response by nivolumab. Surg Case Rep 2018 ; 4 : 71 – reference: 13) Toyota Y, Okamoto K, Tanaka N, et al : Conversion surgery of Stage IV gastric cancer with peritoneal dissemination after nivolumab. Int Cancer Conf J 2021 ; 10 : 280-284 – reference: 10) Chubenko V, Inusilaev G, Imyanitov E, et al : Clinical case of the neoadjuvant treatment with Nivolumab in a patient with microsatellite unstable (MSI-H) locally advanced gastric cancer. BMJ Case Rep 2020 ; 13 : e236144 – reference: 23) Yoshida K, Yasufuku I, Terashima M, et al : International Retrospective Cohort Study of Conversion Therapy for Stage IV Gastric Cancer 1 (CONVO-GC-1). Ann Gastroenterol Surg 2021 ; 6 : 227-240 – reference: 5) Kang YK, Chen LT, Ryu MH, et al : Nivolumab plus chemotherapy versus placebo plus chemotherapy in patients with HER2-negative, untreated, unresectable advanced or recurrent gastric or gastro-oesophageal junction cancer (ATTRACTION-4) : a randomised, multicentre, double-blind, placebo-controlled, phase 3 trial. Lancet Oncol 2022 ; 23 : 234-247 |
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| Snippet | 症例は71歳，男性．前医でHb 6.9mg/dlの貧血を指摘され，当院を受診した．CT・上部消化管内視鏡検査で胃前庭部に肝浸潤を伴った3型腫瘍を認め，cT4b（HEP）N0M0，cStage... |
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| SubjectTerms | nivolumab 完全奏効 進行胃癌 |
| Title | 根治術でNivolumabによる病理学的完全奏効が確認された高度進行胃癌の1例 |
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