2021 Volume 54 Issue 11 Pages 802-812
Immune checkpoint inhibitors have attracted attention as new anticancer agents, but there are many reports of unprecedented immune-related adverse events. The patient was a 70-year-old male who received chemotherapy for unresectable gastric cancer due to para-aortic lymph node metastases. S-1+cisplatin and subsequent paclitaxel chemotherapy were ineffective, but the primary tumor and lymph node metastases were reduced after three courses of nivolumab. However, after four courses, the patient developed painful tense bullae on his whole body, which was diagnosed as bullous pemphigoid, an immune-related adverse event of nivolumab. The blisters were improved with discontinuation of nivolumab and starting of oral steroids. However, the primary tumor then regrew without distant metastases. Total gastrectomy was performed with para-aortic lymph node dissection as conversion surgery. A pathological examination revealed R0 resection of the primary tumor and a complete response for all metastatic lymph nodes. This case shows the effectiveness of curative resection for initially unresectable gastric cancer with appropriate control of adverse events of nivolumab.
