[A Case of Brain Metastasis of Gastric Cancer Successfully Treated with Nivolumab].

A 68‒year‒old man was referred to our hospital due to vomiting and light‒headedness. The patient was diagnosed with advanced gastric cancer. Neoadjuvant chemotherapy(S‒1 plus oxaliplatin)was initiated resulting in a partial response(PR) after 5 courses. Total gastrectomy and D1 dissection was performed. The tumor was diagnosed as poorly differentiated adenocarcinoma and the pathological Stage was ypT3, N3b, M1[CY1], ypStage Ⅳ. Ramucirumab plus nab‒paclitaxel was administered due to the appearance of swollen lymph nodes post‒operatively. This treatment maintained PR for 6 courses. However, after an evaluation of progressive disease(PD), nivolumab was initiated as third‒line chemotherapy. After 3 courses, a sudden seizure occurred and a brain metastasis with a diameter of 6 mm was observed. Considering the decrease in CEA level and that the brain metastasis presented as a small lesion, the tumor was inferred to be highly sensitive to nivolumab. We continued nivolumab monotherapy as chemotherapy. Radiotherapy was not performed. Both intra and extra‒cranial metastatic lesions maintained PR for 17 courses. The treatment was changed to irinotecan after evidence of PD was observed. However, after 2 courses(2 years and 3 months from his first visit), the patient died of an unknown cause. To our knowledge, this is the first case of brain metastasis of gastric cancer successfully treated with nivolumab.

Primary small cell carcinoma of the breast.

Primary small cell carcinoma of the breast is a very rare disease, and only a few case reports have described small cell carcinoma of the breast that responds to chemotherapy. Here, we report a case of primary small cell carcinoma of the breast that was treated with surgery and chemotherapy for postoperative local recurrence in the chest wall and metastasis to the liver. The metastatic lesions showed a partial response (PR) to carboplatin and irinotecan, but did not respond to subsequent Taxotere and doxifluridine (5'-DFUR) treatment. We then treated the metastatic lesions with CBDCA and etoposide (VP-16), and were able to stop disease progression. Small cell carcinoma of the breast is as aggressive as its pulmonary counterpart. Therefore, the best therapy for primary small cell carcinoma of the breast may be surgery followed by adjuvant therapy similar to that recommended for small cell lung carcinoma.