ABSTRACT

A 74-yr-old man underwent thoracic laparoscopy combined with radical gastrectomy, and the postoperative pathological diagnosis was esophageal and gastric cardia cancer pT3N1M0, pStage IIB. Immunohistochemical staining for HER2 (3+) and PD-L1 (<5%) was positive. Adjuvant chemotherapy was not performed because the patient developed severe thrombocytopenia (platelet counts <30 × 10⁹/L), which was never cured throughout the reporting period. At 10.7 months post-surgery, he suffered metastases in multiple organs, including the peritoneum, liver, lung, and bone. Following two cycles of first-line trastuzumab and pembrolizumab (200 mg), he developed immune-related myositis (G2), myocarditis (G2), and hepatitis (G1). Therefore, pembrolizumab was discontinued. Trastuzumab was administered as a monotherapy; meanwhile, adoptive cytokine-induced killer (CIK) cell infusions were initiated. Eight months after the initial immunotherapy, a solitary brain metastasis was detected, and the patient underwent CyberKnife radiosurgery. For second-line therapy, adoptive CIK cell immunotherapy plus trastuzumab was still used. At the time of reporting, the patient had achieved a complete response (CR) in the brain and liver and a partial response (PR) in the ilium, and he had been followed-up for 36.6 months, much longer than the median survival time for patients with advanced GEJ cancer. We suggest that HER2-targeted therapy and immunotherapy with pembrolizumab or CIK adoptive cell infusions prolonged the overall survival of an elderly patient with HER2-positive GEJ cancer with multiple metastases.

摘要

74岁男性，行胸腹腔镜联合胃癌根治术，术后病理诊断为食管贲门癌pT3N1M0，pStage IIB。HER2 (3+) 和 PD-L1 (<5%) 的免疫组织化学染色呈阳性。未进行辅助化疗，因为患者出现严重的血小板减少症（血小板计数 <30 × 10 ⁹/L)，整个报告期内从未治愈。手术后 10.7 个月，他的多个器官发生转移，包括腹膜、肝脏、肺和骨骼。在接受两个周期的一线曲妥珠单抗和派姆单抗（200 毫克）治疗后，他出现了免疫相关性肌炎 (G2)、心肌炎 (G2) 和肝炎 (G1)。因此，pembrolizumab 被停用。曲妥珠单抗作为单一疗法给药；同时，开始了过继性细胞因子诱导的杀伤 (CIK) 细胞输注。初始免疫治疗后八个月，检测到孤立性脑转移，患者接受了 Cyber​​Knife 放射外科手术。二线治疗仍采用过继性CIK细胞免疫疗法加曲妥珠单抗。在报告时，患者的大脑和肝脏达到完全缓解（CR），髂骨部分缓解（PR），随访36.6个月，远长于晚期GEJ癌患者的中位生存时间. 我们建议 HER2 靶向治疗和使用帕博利珠单抗或 CIK 过继细胞输注的免疫治疗可延长 HER2 阳性 GEJ 癌症伴多发转移的老年患者的总生存期。