[A Case of an Elderly Patient with Advanced Gastric Cancer, Who Underwent Safe Multimodality Treatment with Neoadjuvant Chemotherapy, Minimally Invasive Surgery, and Nivolumab].

Japanese prospective randomized trial of JCOG0405 showed that preoperative chemotherapy is one of useful treatment options for far-advanced gastric cancer patients with bulky and/or multiple lymph node metastases. Also, CheckMate649 and ATTRACTION-4 trials clarified the efficacy of immune-checkpoint inhibitor, nivolumab, in recurrent gastric cancer patients. Here, we presented an 87-year-old elderly female patient with far-advanced gastric cancer with bulky lymph nodes who was successfully treated by radical robotic gastrectomy following the low-dose preoperative chemotherapy, and achieved a complete response using nivolumab therapy after recurrences. In this case, the immunohistochemistry of cancer tissues suggested the microsatellite instability due to the deficiency of mismatch repair genes such as MLH1 and PSM2. Taken together, recent advances in chemotherapy and/or immunotherapy and minimally invasive surgery facilitate reasonable and personalized treatments even in super elderly patient with far-advanced gastric cancer.