Nivolumab Therapy for Synchronous ALK-Positive Lung Cancer and Gastric Cancer

Abstract

Nivolumab is an immune checkpoint inhibitor with demonstrated efficacy against several malignant tumors. Alterations in driver oncogenes such as EGFR and ALK are a poor prognostic factor in nivolumab therapy for non-small cell lung cancer (NSCLC), whereas a smoking history is a well-known, favorable prognostic factor. However, an efficacy of nivolumab therapy for multiple primary malignant tumors (MPMTs) has not been reported, and its efficacy for driver oncogene-positive NSCLC in smokers is unclear. Herein, we report the case of a patient with a history of heavy smoking who developed synchronous ALK-positive NSCLC and gastric cancer that responded to nivolumab therapy. A 76-year-old man who was a heavy smoker presented to our hospital with symptoms of hoarseness and dysphagia. He was ultimately diagnosed with ALK-positive advanced NSCLC. An ALK inhibitor (alectinib) was administered, and the lung cancer lesions showed improvement. The alectinib therapy was continued for 5 months. Thereafter, the lesions in the left lower lobe of the lung showed regrowth. During the same period, the patient experienced epigastric pain. Gastrointestinal endoscopy examination revealed gastric cancer. He was administered nivolumab to treat both the lung cancer and the gastric cancer. Two months later, both the lung lesions and the gastric lesions had diminished in size. Nivolumab therapy might be an effective therapy for synchronous MPMTs and NSCLC in heavy smokers, even if the lung cancer possesses driver oncogene mutations.

Clinical use of trastuzumab combined with different chemotherapy regimens in multi‑line treatment of advanced human epidermal growth factor receptor 2‑positive gastric cancer: A case report

“…A phase III trial verified that apatinib treatment significantly improved OS (6.5 vs. 4.7 months) and PFS (2.6 vs. 1.8 months) times following two or more prior lines of failed chemotherapy (36). A number of associated studies regarding immune checkpoint inhibitors, including pembrolizumab and nivolumab, have been performed (37,38). In the present study, when taking the previous treatment and the condition of the patient into account, it was decided that continuing therapy was possible and apatinib was selected as the third-line therapy, which lasted for 4 months and was then changed to the EOX regimen.…”

Successful treatment of gastric cancer after complete response of lung cancer by nivolumab: a case report

“…We searched case reports in PubMed using terms of “gastric cancer”, “lung cancer”, and “nivolumab”, with an unlimited publication period, and found one article with synchronous gastric cancer and lung cancer treated by nivolumab. Yamasaki et al [ 7 ] reported a patient with gastric adenocarcinoma (cT1bN0M0 Stage IA) and lung adenocarcinoma (cT1aN3M1a Stage IV) who had achieved a good response for 3 months with nivolumab. In a Japanese article research in Ichushi using the same terms with an unlimited publication period excluding congress abstracts, we found one case report from Nakamura et al [ 8 ] of gastric adenocarcinoma (cT1bN0M0 Stage IA) and lung squamous cell carcinoma (cT4N3M1a Stage IVa), showing that each cancer had ameliorated and that the effect of nivolumab was maintained over 96 weeks.…”

Immune Checkpoint Inhibitor as a Therapeutic Choice for Double Cancer: A Case Series

“…A small number of patients with MPM have been treated with ICIs (9-17) (Table II). In some cases, both malignancies significantly responded to ICI therapy (9)(10)(11)(12). In other cases, the malignancies responded variably to ICI therapy (14-16).…”