Metastatic gastric neuroendocrine carcinoma treated with repeated chemotherapy and immunotherapy

What happened, in summary

A 61-year-old man was diagnosed in 2020 after more than a month of upper-abdominal discomfort. He underwent laparoscopic radical gastrectomy in May. Pathology showed a large-cell neuroendocrine carcinoma of the stomach with a small adenocarcinoma component and cancer in 4 of 16 lymph nodes examined on the lesser-curvature side. Testing described the tumor as microsatellite stable and HER2-negative.

He received 6 cycles of etoposide and cisplatin through November 2020. In March 2021, imaging found liver lesions, and biopsy confirmed metastatic neuroendocrine carcinoma. The disease was classified as Stage IV. A liver lesion was treated with microwave ablation, followed by additional chemotherapy combined with immunotherapy. Imaging in July and September 2021 showed a partial response.

The cancer later progressed again in the liver, then responded to further treatment before growing once more and involving the pancreatic tail. Several additional regimens were used through 2022 and 2023. After fifth-line treatment with albumin paclitaxel, sofantinib and immunotherapy, April 2023 CT showed smaller liver and pancreatic-tail lesions. Treatment continued through May 2023. He remained in good condition more than 3 years after diagnosis despite repeated periods of response and progression.