Long-term survival with nivolumab followed by irinotecan after total gastrectomy in alpha-fetoprotein-producing gastric cancer: a case report and review of the literature

Abstract

Background: Alpha-fetoprotein-producing gastric cancer (AFPGC) is a rare type of aggressive gastric cancer (GC) with a dismal prognosis. We present a patient with AFPGC who achieved long-term survival through a multidisciplinary approach.

Case presentation: A 67-year-old man with advanced GC was referred to our hospital for systemic chemotherapy. He was diagnosed with cStage IVB AFPGC. During 2nd-line treatment, we could not control bleeding from the GC itself. After complete resection, during chemotherapy, portal venous tumor thrombi (PVTTs) and liver metastases were identified. With nivolumab followed by irinotecan, the PVTTs and liver metastases disappeared. Without immunotherapy and chemotherapy for 23 months, the patient has survived for 48 months so far with no recurrence of GC.

Conclusion: Long-term survival with AFPGC can be accomplished by using several different approaches, such as surgery, immunotherapy, and chemotherapy.

Keywords: Alpha-fetoprotein; Gastric cancer; Long-term survival; Multidisciplinary therapy.

Fig. 1

Endoscopic appearance. a, b Type III tumor at the lesser curvature of the stomach

Fig. 2

Microscopic findings on the biopsied GC. Hematoxylin and eosin staining. a ×100, b ×400

Fig. 3

Abdominal CT. a Irregular mass at the lesser curvature of the stomach (arrowhead). b Enlarged lymph nodes at the lesser curvature of the stomach (arrowheads). c Suspected enlarged paraaortic lymph nodes (arrow)

Fig. 4

Clinical course. As a 2nd therapy, weekly paclitaxel (wPTX) without ramucirumab was administered due to hematemesis. Before surgery, the patient experienced a 2nd hematemesis. wPTX weekly paclitaxel; nivo nivolumab

Fig. 5

Ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI). At the portal venous phase, the portal vein was cut off in the middle. Dilated vessels are observed from the obstruction to peripheral sites, indicating PVTT. a S8, b S6/7