Immunotherapy-based neoadjuvant treatment of gastric cancer with elevated serum AFP: a case report.

[BACKGROUND] Alpha-fetoprotein-producing gastric cancer (AFPGC) is a rare type of gastric cancer with a high degree of malignancy and a poor prognosis. The standardized treatment process for this type of gastric cancer has not yet been defined, and the available treatment options are limited. However, with the development of molecular biology and immunology, more therapeutic options are available for gastric cancer patients. Immunotherapy has made substantial progress in the treatment of many solid tumors, but there are rare reports on the therapeutic efficacy and safety of immune checkpoint inhibitors combined with chemotherapy in patients with AFPGC.

[CASE PRESENTATION] We conducted a retrospective analysis of six Asian patients with AFPGC, among them were four males and two females, aged 61, 66, 63, 72, 70, and 72 years, respectively, all of whom were Asian. Five of the patients achieved pathologic complete response (pCR) and one patient pathologic partial remission by combining chemotherapy and immunotherapy, and no recurrence was observed during postoperative follow-up. Moreover, the treatment was well tolerated and the quality of life of the patients was assured during the treatment period.

[CONCLUSIONS] We report six cases of locally advanced, non-metastatic gastric cancer with elevated AFP, all of which demonstrated a favorable response and were well tolerated by the patients after the use of immune checkpoint inhibitors and neoadjuvant chemotherapy. This study suggests that programmed death receptor 1(PD-1) checkpoint inhibitors plus chemotherapy can benefit patients with AFPGC and provide a reference for the treatment of patients with AFPGC, and its mechanism of action deserves further study.