Metastatic hepatoid gastric adenocarcinoma achieving complete remission with sintilimab

What happened, in summary

A man in his early 60s had undergone radical gastrectomy about a year before he returned with progressive fatigue, dizziness and severe anemia. After stabilization with blood transfusion, endoscopy found a new bleeding mass in the remaining stomach. Biopsy showed poorly differentiated adenocarcinoma with hepatoid features. Imaging also found multiple liver masses, and his AFP level was markedly elevated, supporting metastatic hepatoid gastric adenocarcinoma.

He started S-1 plus oxaliplatin chemotherapy. After 2 cycles, the stomach lesion had become smaller, but a liver mass had enlarged and the overall response was unsatisfactory. Surgery was no longer considered feasible, so the treatment strategy shifted to immunotherapy.

Sintilimab was given for 11 cycles. By the third cycle his condition had clearly improved. During the fifth cycle, endoscopy no longer showed a gastric tumor, CT found no liver metastases and his AFP level had returned to normal. The complete remission was subsequently confirmed, and disease control remained stable during later cycles. Apart from a fever after the first treatment that improved with symptomatic care, the immunotherapy course was continued successfully.