Conversion Surgery after Nivolumab Response in Alpha-fetoprotein-producing Gastric Cancer—A Case Report—

Abstract

The patient was a 73-year-old man who presented to his primary care physician with loss of appetite and general fatigue. An abdominal mass and anemia were detected, and he was referred to our hospital. Computed tomography showed gastric wall thickening and marked enlargement of the #8 lymph node. Upper gastrointestinal endoscopy showed a type-2 lesion mainly on the lesser curvature of the gastric body. Laboratory tests demonstrated elevated CEA and CA19-9 levels, as well as a high alpha-fetoprotein (AFP) level, leading to a diagnosis of AFP-producing gastric cancer (AFPGC). Because radical dissection of the 25-mm #8 lymph node, which was suspected to have invaded the common hepatic artery and pancreatic head, was deemed difficult, combination chemotherapy with CapeOX and nivolumab was administered for six months. As a result, both the primary gastric lesion and the enlarged lymph node showed marked shrinkage, and conversion surgery was planned. The patient underwent open distal gastrectomy. He remains alive without recurrence 12 months after surgery.