ReviewFrontiers in immunology2026
Durable response to FOLFOX plus serplulimab in AFP-producing gastric adenocarcinoma with liver metastases: a case report and literature review.
Review in Frontiers in immunology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: AFP-producing gastric carcinoma (AFPGC) is an uncommon but clinically aggressive subset of gastric cancer with a strong propensity for liver metastasis. Serum alpha-fetoprotein (AFP) is often markedly elevated, whereas tumor AFP immunostaining can be negative, which may complicate recognition and classification. Case presentation: A 67-year-old man presented with epigastric pain. Contrast-enhanced computed tomography showed gastric wall thickening and multiple hepatic metastases. Endoscopic biopsy revealed a poorly differentiated adenocarcinoma with hepatoid/enteroblastic differentiation features. Immunohistochemistry was positive for SALL4, glypican-3, pan-cytokeratin, and nuclear CDX2, and negative for AFP and neuroendocrine markers. Helicobacter pylori testing was negative. Baseline serum AFP was markedly elevated. After intolerance to oral S-1, the patient received FOLFOX plus the PD-1 inhibitor serplulimab, followed by maintenance serplulimab. Treatment was well tolerated, without immune-related adverse events requiring systemic corticosteroids or treatment interruption. Outcomes: Serial magnetic resonance imaging demonstrated marked and sustained shrinkage of hepatic lesions. A RECIST v1.1-based assessment, using available measurements of measurable target lesions, was consistent with a partial response. Serum AFP rapidly normalized and remained within the reference range during maintenance therapy, paralleling the radiologic response. Conclusion: This case suggests that chemo-immunotherapy with platinum-fluoropyrimidine chemotherapy plus PD-1 blockade may yield substantial and durable disease control in selected patients with metastatic AFPGC, even when tumor AFP staining is negative. AFP kinetics provided a rapid and reproducible on-treatment biomarker that complemented imaging. Given the paucity of prospective data in AFP-high gastric cancer, this report is hypothesis-generating and supports further evaluation of chemo-immunotherapy in larger studies.
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