Ocular form of myasthenia gravis which developed as a result of chemoimmunotherapeutic treatment of locally advanced stomach cancer MSI with achievement of pCR
https://doi.org/10.62546/3034-1477-2025-3-1-35-43
Abstract
Immunotherapy (IT) is one of the main ways to treat solid tumors. Indications for IT become more extensive every year, and data on monitoring and treating autoimmune adverse events are accumulating. Rare complications become more common. In this clinical case, we show experience of using chemoimmunotherapy in the neoadjuvant setting of locally advanced gastric cancer with the presence of microsatellite instability and autoimmune adverse event — ocular myasthenia gravis.
About the Authors
A. V. Kyrkunov
City hospital Nо. 40 Kurortny region
Russian Federation
Russian Federation
Alexandr V. Kyrkunov
9 Borisov st., Sestroreck, 197706
N. V. Tyukavina
City hospital Nо. 40 Kurortny region
Russian Federation
Russian Federation
Nina V. Tyukavina
9 Borisov st., Sestroreck, 197706
D. V. Gladishev
City hospital Nо. 40 Kurortny region
Russian Federation
Russian Federation
Dmitry V. Gladishev
9 Borisov st., Sestroreck, 197706
References
1. Mansfield Р.F. Clinical features, diagnosis, and staging of gastric cancer /FACS Section еds.: K. K. Tanabe, J. B. Kruskal, deputy еds.: D. M. F. Savarese, Sh. Grover. 2017.
2. Al-Batran S.E. et al. Histopathological regression after neoadjuvant docetaxel, oxaliplatin, fluorouracil, and leucovorin versus epirubicin, cisplatin, and fluorouracil or capecitabine in patients with resectable gastric or gastrooesophageal junction adenocarcinoma (FLOT4-AIO): results from the phase 2 part of a multicentre, open-label, randomised phase 2/3 trial // The Lancet Oncology. 2016. Vol. 17, No. 12. Р. 1697–1708.
3. Al-Batran S.E. et al. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastrooesophageal junction adenocarcinoma (FLOT4): a randomised, phase 2/3 trial // The Lancet. 2019. Vol. 393, No. 10184. Р. 1948–1957.
4. André T. et al. Neoadjuvant nivolumab plus ipilimumab and adjuvant nivolumab in localized deficient mismatch repair/microsatellite instability-high gastric or esophagogastric junction adenocarcinoma: the GERCOR NEONIPIGA phase II study // Journal of Clinical Oncology. 2023. Vol. 41, No. 2. Р. 255–265.
5. Ilson D.H. KEYNOTE-585: disappointing results for perioperative pembrolizumab in gastric cancer // Translational Gastroenterology and Hepatology. 2024. Vol. 10. Р. 18.
6. Al-Batran S.E. et al. 1429P Pathological regression in patients with microsatellite instability (MSI) receiving perioperative atezolizumab in combination with FLOT vs. FLOT alone for resectable esophagogastric adenocarcinoma: Results from the DANTE trial of the German Gastric Group at the AIO and SAKK // Annals of Oncology. 2021. Vol. 32. Р. S1069.
7. Sun H. et al. 450P Neoadjuvant chemo-immunotherapy in mismatch repair deficient (dMMR)/microsatellite instability (MSI) gastric carcinoma (GC): A multicenter retrospective study // Annals of Oncology. 2024. Vol. 35. Р. S180–S181.
8. Wan T. et al. The prognostic value of a pathologic complete response after neoadjuvant therapy for digestive cancer: systematic review and meta-analysis of 21 studies // Annals of Surgical Oncology. 2019. Vol. 26. Р. 1412–1420.
9. Janjigian Y.Y. et al. Event-free survival (EFS) in MATTERHORN: A randomized, phase 3 study of durvalumab plus 5-fluorouracil, leucovorin, oxaliplatin and docetaxel chemotherapy (FLOT) in resectable gastric/gastroesophageal junction cancer (GC/GEJC) // Journal of Clinical Oncology. 2025. Vol. 43, Nо. 17, suppl. https://doi.org/10.1200/JCO.2025.43.17_suppl.LBA5.
10. Al-Batran S.E. et al. Effect of neoadjuvant chemotherapy followed by surgical resection on survival in patients with limited metastatic gastric or gastroesophageal junction cancer: the AIO-FLOT3 trial // JAMA oncology. 2017. Vol. 3, No. 9. Р. 1237–1244.
11. Janjigian Y.Y. et al. First-line nivolumab plus chemotherapy versus chemotherapy alone for advanced gastric, gastrooesophageal junction, and oesophageal adenocarcinoma (CheckMate 649): a randomised, open-label, phase 3 trial // The Lancet. 2021. Vol. 398, No. 10294. Р. 27–40.
12. Topalian S.L. et al. Five-year survival and correlates among patients with advanced melanoma, renal cell carcinoma, or non-small cell lung cancer treated with nivolumab // JAMA oncology. 2019. Vol. 5, No. 10. Р. 1411–1420.
13. Narita T. et al. Immunotherapy for ocular myasthenia gravis: an observational study in Japan // Therapeutic Advances in Neurological Disorders. 2023. Vol. 16. Р. 17562864231163819.
14. Xiong B.H. et al. An updated meta-analysis of randomized controlled trial assessing the effect of neoadjuvant chemotherapy in advanced gastric cancer // Cancer investigation. 2014. Vol. 32, No. 6. Р. 272–284.
15. Ronellenfitsch U. et al. Perioperative chemo (radio) therapy versus primary surgery for resectable adenocarcinoma of the stomach, gastroesophageal junction, and lower esophagus // Cochrane Database of Systematic Reviews. 2013. No. 5.
16. Diaz‐Nieto R., Orti‐Rodríguez R., Winslet M. Post‐surgical chemotherapy versus surgery alone for resectable gastric cancer // Cochrane Database of Systematic Reviews. 2013. No. 9.
17. Wan T. et al. The prognostic value of a pathologic complete response after neoadjuvant therapy for digestive cancer: systematic review and meta-analysis of 21 studies // Annals of Surgical Oncology. 2019. Vol. 26. Р. 1412–1420.
18. Transverse myelitis. National Organization for Rare Disorders (NORD). https://rarediseases.org/rarediseases/transverse-myelitis/ (Accessed on August 18, 2023).
19. Al-Batran S.E. et al. The RENAISSANCE (AIO-FLOT5) trial: effect of chemotherapy alone vs. chemotherapy followed by surgical resection on survival and quality of life in patients with limited-metastatic adenocarcinoma of the stomach or esophagogastric junction — a phase III trial of the German AIO/CAO-V/CAOGI // BMC cancer. 2017. Vol. 17. Р. 1–7.
Review
For citations:
Kyrkunov A.V., Tyukavina N.V., Gladishev D.V. Ocular form of myasthenia gravis which developed as a result of chemoimmunotherapeutic treatment of locally advanced stomach cancer MSI with achievement of pCR. Clinical Case in Oncology. 2025;3(1):35-43. (In Russ.) https://doi.org/10.62546/3034-1477-2025-3-1-35-43
Views:
19
Email this article 