Gastric cancer intracranial metastases guidelines [Neurosurgery Wiki]

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====== Gastric cancer intracranial metastases guidelines ======

Several clinical trials have proven that the use of PD-1/PD-L1 inhibitors can improve the survival of late-stage GC patients and is suggested in NCCN and CSCO guidelines. However, the correlation between PD-L1 expression and the response to PD-1/PD-L1 inhibitors is still controversial. GC rarely develops brain metastasis (BrM) and currently there is no therapeutic protocol for GC BrMs.

Case presentation: We report a case of a 46-year-old male suffering from GC with PD-L1 negative BrMs 12 years after GC resection and 5 cycles of chemotherapy. We treated the patient with the immune checkpoint inhibitor (ICI) pembrolizumab and all metastatic tumors achieved a complete response (CR). A durable remission of the tumors is confirmed after 4 years of follow-up.

Conclusion: We shared a rare case with PD-L1 negative GC BrM responsive to PD-1/PD-L1 inhibitors, the mechanism of which is still unclear. The protocol of therapeutic choice for late-stage GC with BrM is urgently needed. And we are expecting biomarkers other than PD-L1 expressions to predict the efficacy of ICI treatment
((Wang Q, Shen Z, Ge M, Xu J, Zhang X, Zhu W, Liu J, Hua W, Mao Y. Unexpected curative effect of PD-1 inhibitor in gastric cancer with brain metastasis: A case report. Front Oncol. 2023 Feb 16;13:1042417. doi: 10.3389/fonc.2023.1042417. PMID: 36874117; PMCID: PMC9978328.)).