Case Report: Favorable Response and Manageable Toxicity to the Combination of Camrelizumab, Oxaliplatin, and Oral S-1 in a Patient With Advanced Epstein–Barr Virus-Associated Gastric Cancer

Abstract

Some pertinent studies have demonstrated that Epstein–Barr virus-associated gastric cancer (EBVaGC) patients showed a favorable clinical outcome to immunotherapy and Epstein–Barr virus (EBV)-positive status might be a potential biomarker for immunotherapy in gastric cancer (GC). However, knowledge of given exposure to EBVaGC to the first-line immunotherapy is largely inadequate. Moreover, whether camrelizumab can be as effective as other PD-1 inhibitors in the treatment of advanced EBVaGC has not been reported. We report a case of advanced EBVaGC patient with a positive expression of PD-L1, enriched PD-L1+CD68+macrophages, and high TMB who had a long-term partial response and manageable toxicity to the combined approach of camrelizumab (a novel PD-1 inhibitor) and oxaliplatin plus oral S-1 (SOX). As the first-line treatment of advanced EBVaGC patients, camrelizumab combined with SOX regimen may provide a novel combined approach with favorable response and manageable safety. Combination of multiple biomarkers could have a higher effective predictive capacity to immunotherapy. Integrated treatment (chemo-immunotherapy and radiotherapy) might be the optimal strategy for patients with oligometastasis. It deserves prospective research to further validate the efficacy.

Case report: Long response to PD-1 blockade after failure of trastuzumab plus chemotherapy in advanced Epstein-Barr virus-associated gastric cancer

“…Besides, the PFS of our case (beyond 20 months) was more prominent, and it could be translated into long-term survival. Similar results had been reported ( 10 ), which may attribute to the unique characteristics of EBV-related cancers. The present case indicated EBV was a strong biomarker for the immunotherapy of GC.…”

Case report: Nutritionally supported perioperative chemo-immunotherapy for advanced gastric cancer with incomplete pyloric obstruction

“…After comparing and summarizing several previous studies, immunotherapy plus chemotherapy showed better treatment effects for gastric cancer patients ( 22 ). At the same time, immunotherapy plus chemotherapy can achieve a good prognosis of gastric cancer patients while reducing toxic side effects, which has also been reported in previous case reports ( 23 – 25 ). In our case, the patient suffered from gastrointestinal and myelosuppressive side effects due to intravenous oxaliplatin.…”

Case report: Immunotherapy plus chemotherapy and stereotactic ablative radiotherapy (ICSABR): a novel treatment combination for Epstein-Barr virus-associated lymphoepithelioma-like intrahepatic cholangiocarcinoma

“…However, the expected tumor regression was not attained. Compared with a previous case of EBV-associated gastric cancer, the present case had a less abundant TIME, such as CD8 + T cell density (10.59% vs. 2.87%) (Lv et al, 2022). Compared with EBVa ICC, EBVa LEL-ICC had significantly increased densities of CD8 + T cells (Huang et al, 2021).…”

“…EBV-associated cancer is significantly responsive to immunotherapy. This response has been documented in previous cases of stomach, lung, liver, and bile duct cancer (Jiang et al, 2015;Xie et al, 2020;Huang et al, 2021;Lv et al, 2022;Zhu et al, 2022). Its sensitivity to immunotherapy was related to the upregulated expression of programmed death ligand 1 (PD-L1) (Wang et al, 2022).…”