MSI-H的晚期残胃癌患者接受免疫治疗一例报道及文献复习
A Case Report and Literature Review of Patients with Advanced Residual Gastric Cancer with MSI-H Receiving Immunotherapy
DOI: 10.12677/ACM.2023.1381902, PDF,   
作者: 顾文谨, 刘春淦, 徐艳霞*：青岛大学附属青岛市中心医院中西医结合科，山东 青岛
关键词: 残胃癌；微卫星不稳定；免疫治疗；PD-L1；Residual Gastric Cancer； Microsatellite Instability； Immunotherapy； PD-L1
摘要: 胃癌(gastric cancer, GC)是世界范围内第五大常见恶性肿瘤，也是癌症相关死亡的第四大原因。目前，晚期胃癌的治疗方法主要是化疗和靶向治疗，免疫治疗也已成为胃癌的新治疗选择。2017年帕博利珠单抗被美国FDA批准用于PD-L1表达的局部晚期或转移性胃或胃食管结合部癌(gastric can-cer/gastroesophageal junction carcinoma, GC/GEJC)。此外，胃癌中高度微卫星不稳定(microsatellite instability-high, MSI-H)的患者更可能出现PD-L1过度表达，对于免疫治疗显示出更好的疗效。残胃癌(gastric stump cancer, GSC)是指胃术后残胃发生的癌，包括胃良性疾病术后5年以上残胃原发的癌及胃恶性肿瘤行胃切除术后10年以上，残胃出现的新发癌。对于不能手术切除的残胃癌，可参考胃癌的治疗方法。但对于残胃癌是否可以从免疫疗法中获益的临床证据有限。在本文中，回顾了一名MSI-H、体力状态较差的88岁男性晚期残胃癌患者在接受单药免疫治疗后，疗效达到部分缓解的过程，旨在分析总结病例，为今后该类患者的诊治提供借鉴。
Abstract: Gastric cancer (GC) is the fifth most common malignant tumor worldwide and the fourth leading cause of cancer-related deaths. At present, chemotherapy and targeted therapy are the main treatment methods for advanced gastric cancer. Immunotherapy has also become a new treatment option for gastric cancer. In 2017, pembrolizumab was approved by the US FDA for use in locally advanced or metastatic gastric cancer or gastroesophageal junction carcinoma (GC/GEJC) expressing PD-L1. In addition, patients with highly microsatellite instability high (MSI-H) in gastric cancer are more likely to experience overexpression of PD-L1, which shows better efficacy in immunotherapy. Gastric stump cancer (GSC) refers to the cancer of the remnant stomach after gastric surgery, in-cluding the primary cancer of the remnant stomach more than 5 years after the operation of benign gastric diseases and the new cancer of the remnant stomach more than 10 years after gastrectomy of gastric malignancies. For residual gastric cancer that cannot be surgically removed, reference can be made to the treatment methods for gastric cancer. However, there is limited clinical evidence on whether residual gastric cancer can benefit from immunotherapy. In this article, a review was con-ducted on an 88-year-old male patient with MSI-H and poor physical condition who achieved partial remission after receiving monotherapy immunotherapy for advanced gastric cancer. The aim was to analyze and summarize the case and provide reference for the diagnosis and treatment of this type of patient in the future.
文章引用：顾文谨, 刘春淦, 徐艳霞. MSI-H的晚期残胃癌患者接受免疫治疗一例报道及文献复习[J]. 临床医学进展, 2023, 13(8): 13610-13615. https://doi.org/10.12677/ACM.2023.1381902

参考文献

[1] Xia, C., Dong, X., Li, H., Cao, M., Sun, D., He, S., et al. (2022) Cancer Statistics in China and United States, 2022: Pro-files, Trends, and Determinants. Chinese Medical Journal, 135, 584-590. [Google Scholar] [CrossRef] 
[2] Petrillo, A., Pompella, L., Tirino, G., Pappalardo, A., Later-za, M.M., Caterino, M., et al. (2019) Perioperative Treatment in Resectable Gastric Cancer: Current Perspectives and Fu-ture Directions. Cancers, 11, 399. [Google Scholar] [CrossRef] [PubMed]
[3] Li, K., Luo, H., Huang, L., Luo, H. and Zhu, X. (2020) Microsatel-lite Instability: A Review of What the Oncologist Should Know. Cancer Cell International, 20, Article No. 16. [Google Scholar] [CrossRef] [PubMed]
[4] Smyth, E.C., Wotherspoon, A., Peckitt, C., Gonzalez, D., Hulk-ki-Wilson, S., Eltahir, Z., et al. (2017) Mismatch Repair Deficiency, Microsatellite Instability, and Survival: An Explora-tory Analysis of the Medical Research Council Adjuvant Gastric Infusional Chemotherapy (MAGIC) Trial. JAMA On-cology, 3, 1197-1203. [Google Scholar] [CrossRef] [PubMed]
[5] Pietrantonio, F., Randon, G., Di Bartolomeo, M., Luciani, A., Chao, J., et al. (2021) Predictive Role of Microsatellite Instability for PD-1 Blockade in Patients with Advanced Gastric Cancer: A Meta-Analysis of Randomized Clinical Trials. ESMO Open, 6, Article ID: 100036. [Google Scholar] [CrossRef] [PubMed]
[6] Sung, H., Ferlay, J., Siegel, R.L., Laversanne, M., Soerjomata-ram, I., Jemal, A. and Bray, F. (2021) Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: A Cancer Journal for Clinicians, 71, 209-249. [Google Scholar] [CrossRef] [PubMed]
[7] Green, P.H., O’Toole, K.M., Slonim, D., Wang, T. and Weg, A. (1988) Increasing Incidence and Excellent Survival of Patients with Early Gastric Cancer: Experience in a United States Medical Center. The American Journal of Medicine, 85, 658-661. [Google Scholar] [CrossRef] 
[8] Li, P., Huang, C.M., Zheng, C.H., Russo, A., Kasbekar, P., Brennan, M.F., Coit, D.G. and Strong, V.E. (2018) Comparison of Gastric Cancer Survival after R0 Resection in the US and China. Journal of Surgical Oncology, 118, 975-982. [Google Scholar] [CrossRef] [PubMed]
[9] Glimelius, B., Ekström, K., Hoffman, K., Graf, W., Sjödén, P.O., Haglund, U., et al. (1997) Randomized Comparison between Chemotherapy plus Best Supportive Care with Best Supportive Care in Advanced Gastric Cancer. Annals of Oncology: Official Journal of the European Society for Medical Oncology, 8, 163-168. [Google Scholar] [CrossRef] 
[10] Bang, Y.J., Van Cutsem, E., Feyereislova, A., Chung, H.C., Shen, L., Sawaki, A., et al. (2010) Trastuzumab in Combination with Chemotherapy versus Chemotherapy Alone for Treatment of HER2-Positive Advanced Gastric or Gastro-Oesophageal Junction Cancer (ToGA): A Phase 3, Open-Label, Ran-domised Controlled Trial. The Lancet, 376, 687-697. [Google Scholar] [CrossRef] 
[11] Fuchs, C.S., Tomasek, J., Yong, C.J., Dumitru, F., Passalacqua, R., Goswami, C., et al. (2014) Ramucirumab Monotherapy for Previously Treated Advanced Gastric or Gastro-Oesophageal Junction Adenocarcinoma (REGARD): An International, Randomised, Multicentre, Placebo-Controlled, Phase 3 Trial. The Lancet, 383, 31-39. [Google Scholar] [CrossRef] 
[12] Li, J., Qin, S., Xu, J., Xiong, J., Wu, C., Bai, Y., et al. (2016) Randomized, Double-Blind, Placebo-Controlled Phase III Trial of Apatinib in Patients with Chemotherapy-Refractory Advanced or Metastatic Adenocarcinoma of the Stomach or Gastroesophageal Junction. Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology, 34, 1448-1454. [Google Scholar] [CrossRef] 
[13] 梁寒. 中国残胃癌定义的外科专家共识意见(2018年版)解读[J]. 临床外科杂志, 2019, 27(1): 29-31.
[14] Zhang, Q.F., Li, J., Jiang, K., Wang, R., Ge, J.L., Yang, H., Liu, S.J., et al. (2020) CDK4/6 Inhibition Promotes Immune Infiltration in Ovarian Cancer and Synergizes with PD-1 Blockade in a B Cell-Dependent Manner. Theranostics, 10, 10619-10633. [Google Scholar] [CrossRef] [PubMed]
[15] Chao, J., Fuchs, C.S., Shitara, K., Tabernero, J., Muro, K., Van Cutsem, E., et al. (2021) Assessment of Pembrolizumab Therapy for the Treatment of Microsatellite Instability-High Gastric or Gastroesophageal Junction Cancer among Patients in the KEYNOTE-059, KEYNOTE-061, and KEYNOTE-062 Clinical Trials. JAMA Oncology, 7, 895-902. [Google Scholar] [CrossRef] [PubMed]
[16] Shitara, K., Özgüroğlu, M., Bang, Y.J., Di Bartolomeo, M., Mandalà, M., Ryu, M.H., et al. (2018) Pembrolizumab versus Paclitaxel for Previously Treated, Advanced Gastric or Gastro-Oesophageal Junction Cancer (KEYNOTE-061): A Randomised, Open-Label, Controlled, Phase 3 Trial. The Lancet, 392, 123-133. [Google Scholar] [CrossRef] 
[17] Shitara, K., Van Cutsem, E., Bang, Y.J., Fuchs, C., Wyrwicz, L., Lee, K.W., et al. (2020) Efficacy and Safety of Pembrolizumab or Pembrolizumab plus Chemotherapy vs Chemotherapy Alone for Patients with First-Line, Advanced Gastric Cancer: The KEYNOTE-062 Phase 3 Randomized Clinical Trial. JAMA Oncology, 6, 1571-1580. [Google Scholar] [CrossRef] [PubMed]
[18] Janjigian, Y.Y., Shitara, K., Moehler, M., Garrido, M., Salman, P., Shen, L., et al. (2021) 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. The Lancet, 398, 27-40. [Google Scholar] [CrossRef] 
[19] Xu, J., Jiang, H., Pan, Y., Gu, K., Cang, S., Han, L., et al. (2021) LBA53 Sintilimab plus Chemotherapy (Chemo) versus Chemo as First-Line Treatment for Advanced Gastric or Gastroesophageal Junction (G/GEJ) Adenocarcinoma (ORIENT-16): First Results of a Randomized, Double-Blind, Phase III Study. Annals of Oncology, 32, S1331. [Google Scholar] [CrossRef] 
[20] Accordino, G., Lettieri, S., Bortolotto, C., Benvenuti, S., Gal-lotti, A., Gattoni, E., et al. (2020) From Interconnection between Genes and Microenvironment to Novel Immunothera-peutic Approaches in Upper Gastro-Intestinal Cancers—A Multidisciplinary Perspective. Cancers, 12, Article No. 2105. [Google Scholar] [CrossRef] [PubMed]
[21] Li, J., Deng, Y., Zhang, W., Zhou, A.P., Guo, W., Yang, J., et al. (2021) Subcutaneous Envafolimab Monotherapy in Patients with Advanced Defective Mismatch Repair/Microsatellite Instability High Solid Tumors. Journal of Hematology & Oncology, 14, Article No. 95. [Google Scholar] [CrossRef] [PubMed]
[22] Lagergren, J., Lindam, A. and Mason, R.M. (2012) Gastric Stump Cancer after Distal Gastrectomy for Benign Gastric Ulcer in a Population-Based Study. International Journal of Cancer, 131, E1048-E1052. [Google Scholar] [CrossRef] [PubMed]
[23] Hanyu, T., Wakai, A., Ishikawa, T., Ichikawa, H., Kameyama, H. and Wakai, T. (2018) Carcinoma in the Remnant Stomach during Long-Term Follow-Up after Distal Gastrectomy for Gastric Cancer: Analysis of Cumulative Incidence and Associated Risk Factors. World Journal of Surgery, 42, 782-787. [Google Scholar] [CrossRef] [PubMed]
[24] Ramos, M., Pereira, M.A., de Castria, T.B., Ribeiro, R.R.E., Car-dili, L., de Mello, E.S., et al. (2020) Remnant Gastric Cancer: A Neglected Group with High Potential for Immunothera-py. Journal of Cancer Research and Clinical Oncology, 146, 3373-3383. [Google Scholar] [CrossRef] [PubMed]

为你推荐