BACKGROUND The treatment of gastric cancer remains highly challenging,particularly in cases of unresectable locally advanced or metastatic disease.Although chemotherapy and immunotherapy have shown some efficacy in su...BACKGROUND The treatment of gastric cancer remains highly challenging,particularly in cases of unresectable locally advanced or metastatic disease.Although chemotherapy and immunotherapy have shown some efficacy in such patients,significant limitations persist in extending survival and enhancing safety.To address these challenges,we designed an innovative first-line quadruple conversion therapy regimen that integrates a programmed cell death protein 1(PD-1)inhibitor with chemotherapy,and we successfully implemented this therapy regimen in the treatment of a patient with unresectable locally advanced gastric adenocarcinoma.CASE SUMMARY We report the case of a 55-year-old male who was diagnosed with unresectable locally advanced gastric adenocarcinoma and presented with intermittent epigastric pain and multiple lymph node metastases in the abdominal cavity,with the metastasis being notably large in size.The tumor tissue was negative for human epidermal growth factor receptor 2 by immunohistochemistry.Considering the patient's status,the multidisciplinary team decided to administer sintilimab in combination with albumin-bound paclitaxel(nab-paclitaxel),S-1,and oxaliplatin as a quadruple drug conversion therapy.After 4 cycles of conversion therapy,the patient's epigastric pain was significantly alleviated,his stool color normalized,the volume of the primary tumor and lymph node metastases was markedly reduced,and the tumor marker levels decreased to within the normal range.The patient subsequently underwent laparoscopic total gastrectomy with abdominal lymph node dissection,and postoperative pathological biopsy revealed a pathological complete response and R0 resection,after which the patient recovered to an excellent physical status.CONCLUSION To the best of our knowledge,this is the first reported case of unresectable locally advanced gastric adenocar-cinoma successfully treated with quadruple therapy with a PD-1 inhibitor and chemotherapy as a first-line conversion regimen.This first-line conversion therapy with the quadruple regimen may be effective and safe for unresectable locally advanced gastric adenocarcinoma.展开更多
Treatment of locally advanced unresectable pancreatic cancer remains a major clinical challenge due to pronounced heterogeneity and resistance to standard regimens.Increasing evidence highlights the critical role of t...Treatment of locally advanced unresectable pancreatic cancer remains a major clinical challenge due to pronounced heterogeneity and resistance to standard regimens.Increasing evidence highlights the critical role of the tumor microenvironment(TME)in shaping therapeutic response and driving drug resistance.In this minireview,we summarize recent advances in TME phenotyping and its potential to guide precision therapy.A four-dimensional framework integrating stromal,immune,genomic,and metabolic features has been proposed to better characterize TME heterogeneity.Preclinical and clinical studies indicate that strategies targeting the stroma,modulating immunity,or exploiting genomic vulnerabilities such as homologous recombination deficiency may enhance the efficacy of chemotherapy,immunotherapy,and targeted agents.Dynamic biomarkers,including circulating tumor DNA and carbohydrate antigen 19-9,also show promise for real-time therapy adaptation,although their clinical application remains limited.By synthesizing current evidence,we emphasize the importance of individualized treatment strategies that account for TME complexity.While encouraging,the translation of multiomics phenotyping and biomarker monitoring into routine clinical practice requires standardization,prospective validation,and integration of novel technologies.Future research should focus on establishing reproducible TME-guided models to enable dynamic and personalized therapy for patients with unresectable pancreatic cancer.展开更多
A 68-year-old female visited a local clinic with epigastralgia. A routine laboratory test revealed jaundice and liver dysfunction. She was referred to this hospital. Abdominal computed tomography (CT) and endoscopic r...A 68-year-old female visited a local clinic with epigastralgia. A routine laboratory test revealed jaundice and liver dysfunction. She was referred to this hospital. Abdominal computed tomography (CT) and endoscopic retrograde cholangio-pancreatography (ERCP) revealed that the density of the entire pancreas had decreased,and showed dilatation of the common bile duct (CBD) and the main pancreatic duct (MPD). Pancreatic cancer was diagnosed by cytological examination analyzing the pancreatic juice obtained by ERCP. When jaundice had decreased the tumor was observed via laparotomy. No ascites,liver metastasis,or peritoneal dissemination was observed. The entire pancreas was a hard mass,and a needle biopsy was obtained from the head,body and tail of the pancreas. These biopsies diagnosed a poorly differentiated adenocarcinoma. Hepaticojejunostomy was thus performed,and postoperative progress was good. Chemotherapy with 1000 mg/body per week of gemcitabine was administered beginning 15 d postoperatively. However,the patient suffered relatively severe side effects,and it was necessary to change the dosing schedule of gemcitabine. Abdominal CT revealed a complete response (CR) after 3 treatments. Therefore,weekly chemotherapy was stopped and was changed to monthly administration. To date,for 4 years after chemotherapy,the tumor has not reappeared.展开更多
基金Supported by the Health Industry Research Program of Gansu Province,No.GSWSKY2021-043the Youth Science and Technology Foundation of Gansu Province,No.22JR11RA002the Natural Science Foundation of Gansu Province,No.22JR5RA008.
文摘BACKGROUND The treatment of gastric cancer remains highly challenging,particularly in cases of unresectable locally advanced or metastatic disease.Although chemotherapy and immunotherapy have shown some efficacy in such patients,significant limitations persist in extending survival and enhancing safety.To address these challenges,we designed an innovative first-line quadruple conversion therapy regimen that integrates a programmed cell death protein 1(PD-1)inhibitor with chemotherapy,and we successfully implemented this therapy regimen in the treatment of a patient with unresectable locally advanced gastric adenocarcinoma.CASE SUMMARY We report the case of a 55-year-old male who was diagnosed with unresectable locally advanced gastric adenocarcinoma and presented with intermittent epigastric pain and multiple lymph node metastases in the abdominal cavity,with the metastasis being notably large in size.The tumor tissue was negative for human epidermal growth factor receptor 2 by immunohistochemistry.Considering the patient's status,the multidisciplinary team decided to administer sintilimab in combination with albumin-bound paclitaxel(nab-paclitaxel),S-1,and oxaliplatin as a quadruple drug conversion therapy.After 4 cycles of conversion therapy,the patient's epigastric pain was significantly alleviated,his stool color normalized,the volume of the primary tumor and lymph node metastases was markedly reduced,and the tumor marker levels decreased to within the normal range.The patient subsequently underwent laparoscopic total gastrectomy with abdominal lymph node dissection,and postoperative pathological biopsy revealed a pathological complete response and R0 resection,after which the patient recovered to an excellent physical status.CONCLUSION To the best of our knowledge,this is the first reported case of unresectable locally advanced gastric adenocar-cinoma successfully treated with quadruple therapy with a PD-1 inhibitor and chemotherapy as a first-line conversion regimen.This first-line conversion therapy with the quadruple regimen may be effective and safe for unresectable locally advanced gastric adenocarcinoma.
文摘Treatment of locally advanced unresectable pancreatic cancer remains a major clinical challenge due to pronounced heterogeneity and resistance to standard regimens.Increasing evidence highlights the critical role of the tumor microenvironment(TME)in shaping therapeutic response and driving drug resistance.In this minireview,we summarize recent advances in TME phenotyping and its potential to guide precision therapy.A four-dimensional framework integrating stromal,immune,genomic,and metabolic features has been proposed to better characterize TME heterogeneity.Preclinical and clinical studies indicate that strategies targeting the stroma,modulating immunity,or exploiting genomic vulnerabilities such as homologous recombination deficiency may enhance the efficacy of chemotherapy,immunotherapy,and targeted agents.Dynamic biomarkers,including circulating tumor DNA and carbohydrate antigen 19-9,also show promise for real-time therapy adaptation,although their clinical application remains limited.By synthesizing current evidence,we emphasize the importance of individualized treatment strategies that account for TME complexity.While encouraging,the translation of multiomics phenotyping and biomarker monitoring into routine clinical practice requires standardization,prospective validation,and integration of novel technologies.Future research should focus on establishing reproducible TME-guided models to enable dynamic and personalized therapy for patients with unresectable pancreatic cancer.
文摘A 68-year-old female visited a local clinic with epigastralgia. A routine laboratory test revealed jaundice and liver dysfunction. She was referred to this hospital. Abdominal computed tomography (CT) and endoscopic retrograde cholangio-pancreatography (ERCP) revealed that the density of the entire pancreas had decreased,and showed dilatation of the common bile duct (CBD) and the main pancreatic duct (MPD). Pancreatic cancer was diagnosed by cytological examination analyzing the pancreatic juice obtained by ERCP. When jaundice had decreased the tumor was observed via laparotomy. No ascites,liver metastasis,or peritoneal dissemination was observed. The entire pancreas was a hard mass,and a needle biopsy was obtained from the head,body and tail of the pancreas. These biopsies diagnosed a poorly differentiated adenocarcinoma. Hepaticojejunostomy was thus performed,and postoperative progress was good. Chemotherapy with 1000 mg/body per week of gemcitabine was administered beginning 15 d postoperatively. However,the patient suffered relatively severe side effects,and it was necessary to change the dosing schedule of gemcitabine. Abdominal CT revealed a complete response (CR) after 3 treatments. Therefore,weekly chemotherapy was stopped and was changed to monthly administration. To date,for 4 years after chemotherapy,the tumor has not reappeared.
