クリニカルフェローの鈴木宏清先生筆頭の多施設共同研究の論文がInternational Journal of Clinical Oncologyにアクセプトされました。

（詳細） 　進行胃癌の三次治療に免疫チェックポイント阻害薬のニボルマブが標準治療として使用されています。しかし、大量腹水を合併された患者さんに対するニボルマブの有用性に関する報告はこれまでにありませんでした。
　本研究では、県内3施設で治療を受けられた72名の患者さんの診療情報を後方指的に検討した結果、中大量腹水を合併した患者さんの27%で腹水が減少・消失し、長期生存を得ていることが示されました。また、そうした患者さんは治療開始時のNLR（Neutrophil-Lymphocyte ratio）が低い傾向にあることが示されました。
　この度、本臨床研究の論文がInternational Journal of Clinical Oncologyに受理されましたので、ご報告いたします。当科では、引き続き患者さんに寄り添った最善の医療を提供できるよう努めてまいります。
筑波大学消化器内科　山田武史

Retrospective analysis for the efficacy and safety of nivolumab in advanced gastric cancer patients according to ascites burden
Hirosumi Suzuki, Takeshi Yamada, Akinori Sugaya, Shunsuke Ueyama、Yoshiyuki Yamamoto, Toshikazu Moriwaki, Ichinosuke Hyodo
Background: Nivolumab is a standard later-line therapy for advanced gastric cancer (AGC). However, few reports exist about its efficacy and safety in patients with massive ascites.
Methods: We retrospectively collected clinical data from 72 AGC patients who received nivolumab administration at least once from Oct 2017 to Feb 2019 and studied their clinical outcomes dividing into two groups: 50 patients with no or localized ascites in the pelvic cavity or liver surface (LAB: low ascites burden) and 22 patients with massive ascites (HAB: high ascites burden).
Results: Median overall survival (OS) was 5.3 months (95% CI, 3.4-7.3) in the LAB group and 2.5 months (95% CI, 0.0-5.0) in the HAB group. Multivariate Cox regression analysis for OS revealed blood neutrophil-to-lymphocyte ratio (hazard ratio 0.40, 95% CI 0.20-0.83, p = 0.013) as an independent prognostic factor. Response rates in the patients with measurable lesions were 16% (7/43) and 8% (1/12) in the LAB and HAB groups, respectively. Ascites decreased or disappeared in 6 HAB patients (27%) and these responders had a prolonged OS of median 9.7 months (95% CI, 3.6-15.8). The median time to ascites response was 1.3 months (95%CI 0.8-1.9). These responders have lower neutrophil-to-lymphocyte ratios than 5.0 at the start of nivolumab. Immune-related adverse events occurred in 23% of HAB and 18% of LAB patients.
Conclusions: Nivolumab could improve massive ascites and confer survival benefit for some AGC patients. Considering a similar incidence of immune-related adverse events, it would be a recommended treatment option for AGC with massive ascites.