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Title: Salvage treatment using anti-PD-1/CTLA-4 immunotherapy after failure of neoadjuvant chemotherapy in microsatellite instable gastroesophageal carcinoma.
Austin Authors: Klein, Oliver ;Brown, Wendy A;Saxon, Sarah;Haydon, Andrew
Affiliation: Olivia Newton-John Cancer Research Institute
Department of Anatomical Pathology, Alfred Health, Melbourne, Australia
Department of Surgery, Alfred Health, Melbourne, Australia
Department of Medical Oncology, Alfred Health, Australia
Issue Date: Jun-2021
Date: 2021-04-15
Publication information: The Oncologist 2021; 26(6): 461-464
Abstract: Perioperative chemotherapy is standard treatment for patients with early high risk gastroesophageal adenocarcinoma independent of molecular subtype. Around 8 % of gastroesophageal cancers have a microsatellite instable phenotype (MSI-H) and retrospective analyses of neoadjuvant-/adjuvant chemotherapy trials suggest no survival benefit in this patient population compared to surgery alone. Patients with advanced MSI-H malignancies obtain durable responses with immunotherapy using anti-PD-1 checkpoint blockade. We describe a case of a patient with an early MSI-H gastroesophageal adenocarcinoma who progressed on neoadjuvant chemotherapy precluding subsequent surgical resection. The patient was subsequently treated with immunotherapy using the anti-PD-1 antibody nivolumab and the anti-CTLA-4 antibody ipilimumab leading to a complete remission with biopsies of the residual tumour mass and regional lymph nodes revealing no residual tumour. This case highlights the lack of benefit from neoadjuvant chemotherapy in patients with MSI-H gastroesophageal cancers and suggests that perioperative anti-PD-1 based immunotherapy should be further investigated in this patient population. KEYPOINTS: This reports describes the successful salvage treatment of a patient with an early high risk MSI-H gastroesophageal carcinoma who progressed through neoadjuvant chemotherapy using combination immunotherapy of the anti-PD-1 antibody nivolumab and the anti-CTLA-4 antibody ipilimumab, leading to an ongoing complete remission. The case is in keeping with retrospective analyses of perioperative treatment trials demonstrating a lack of chemotherapy benefit in patients with MSI-H gastroesophageal carcinoma and supports the further investigation of anti-PD-1 based immunotherapy as treatment modality in this patient population. The case highlights the potential difficulties that may be encountered in the surgical management of patients treated with neoadjuvant immunotherapy with reactive dense fibrotic changes precluding surgical resection.
DOI: 10.1002/onco.13793
Journal: The Oncologist
PubMed URL: 33856094
Type: Journal Article
Subjects: CTLA-4
gastroesophageal carcinoma
Appears in Collections:Journal articles

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