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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Quadruple therapy with immunotherapy and chemotherapy as first-line conversion treatment for unresectable advanced gastric adenocarcinoma: A case report
Xiao-Yu Du, Ren-Jie Xia, Li-Wen Shen, Jian-Guo Ma, Wei-Qing Yao, Wei Xu, Zhi-Peng Lin, Liang-Bin Ma, Guo-Qiang Niu, Rui-Fang Fan, Shu-Mei Xu, Long Yan
Xiao-Yu Du, Ren-Jie Xia, Jian-Guo Ma, Wei-Qing Yao, Wei Xu, Zhi-Peng Lin, Liang-Bin Ma, Guo-Qiang Niu, Rui-Fang Fan, Shu-Mei Xu, Long Yan, Department of Hepatobiliary Surgery and General Surgery, The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
Xiao-Yu Du, Ren-Jie Xia, Wei-Qing Yao, Department of Medicine, Northwest Minzu University, Lanzhou 730050, Gansu Province, China
Li-Wen Shen, Department of Medical Support Center, The 940th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
Jian-Guo Ma, First School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou 730030, Gansu Province, China
Co-first authors: Xiao-Yu Du and Ren-Jie Xia.
Co-corresponding authors: Shu-Mei Xu and Long Yan.
Author contributions: Du XY, Xia RJ and Shen LW contributed equally to this work; Xu SM and Yan L contributed equally to this work as co-corresponding authors; Du XY was responsible for drafting of the manuscript; Xu SM and Yan L were responsible for planning treatment decisions; Xia RJ, Shen LW and Ma JG were responsible for evaluating imaging outcome; Du XY and Xia RJ were listed as co-first authors; Yao WQ and Xu W were responsible for pathological interpretation; Du XY, Xia RJ, Shen LW, Ma JG, Xu W, Lin ZP, Ma LB, Niu GQ, Fan RF, Xu SM and Yan L were responsible for clinical data analysis and taking care of the patient; all authors contributed to the article and approved the submitted version.
Supported by the Health Industry Research Program of Gansu Province, No. GSWSKY2021-043; the Youth Science and Technology Foundation of Gansu Province, No. 22JR11RA002; and the Natural Science Foundation of Gansu Province, No. 22JR5RA008.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Long Yan, MD, Associate Chief Physician, Department of Hepatobiliary Surgery and General Surgery, The 940
th Hospital of Joint Logistic Support Force of Chinese People’s Liberation Army, No. 333 Nanbinhe Middle Road, Qilihe District, Lanzhou 730050, Gansu Province, China.
lzzy940@163.com
Received: October 13, 2024
Revised: January 20, 2025
Accepted: February 24, 2025
Published online: April 15, 2025
Processing time: 163 Days and 6 Hours
BACKGROUND
The treatment of gastric cancer remains highly challenging, particularly in cases of unresectable locally advanced or metastatic disease. Although chemotherapy and immunotherapy have shown some efficacy in such patients, significant limitations persist in extending survival and enhancing safety. To address these challenges, we designed an innovative first-line quadruple conversion therapy regimen that integrates a programmed cell death protein 1 (PD-1) inhibitor with chemotherapy, and we successfully implemented this therapy regimen in the treatment of a patient with unresectable locally advanced gastric adenocarcinoma.
CASE SUMMARY
We report the case of a 55-year-old male who was diagnosed with unresectable locally advanced gastric adenocarcinoma and presented with intermittent epigastric pain and multiple lymph node metastases in the abdominal cavity, with the metastasis being notably large in size. The tumor tissue was negative for human epidermal growth factor receptor 2 by immunohistochemistry. Considering the patient's status, the multidisciplinary team decided to administer sintilimab in combination with albumin-bound paclitaxel (nab-paclitaxel), S-1, and oxaliplatin as a quadruple drug conversion therapy. After 4 cycles of conversion therapy, the patient's epigastric pain was significantly alleviated, his stool color normalized, the volume of the primary tumor and lymph node metastases was markedly reduced, and the tumor marker levels decreased to within the normal range. The patient subsequently underwent laparoscopic total gastrectomy with abdominal lymph node dissection, and postoperative pathological biopsy revealed a pathological complete response and R0 resection, after which the patient recovered to an excellent physical status.
CONCLUSION
To the best of our knowledge, this is the first reported case of unresectable locally advanced gastric adenocarcinoma successfully treated with quadruple therapy with a PD-1 inhibitor and chemotherapy as a first-line conversion regimen. This first-line conversion therapy with the quadruple regimen may be effective and safe for unresectable locally advanced gastric adenocarcinoma.
Core Tip: The prognosis for patients with unresectable or metastatic gastric cancer remains poor. The efficacy and safety of chemotherapy and immunotherapy require further improvement. We have designed an innovative first-line quadruple conversion therapy regimen that integrates a programmed cell death protein 1 inhibitor with chemotherapy, successfully implemented in the treatment of a patient with unresectable locally advanced gastric adenocarcinoma.
