Successful treatment with nivolumab in a patient with gastric cancer with severe liver failure resulting from multiple liver metastases: A case report

Gastric cancer (GC) is a globally prevalent and deadly malignancy often diagnosed at advanced stages, which can be accompanied by liver metastases. Conventional chemotherapy is contraindicated in patients with severe liver failure because several chemotherapeutic agents are metabolized by the liver. The present study reports on the successful use of nivolumab in a patient with advanced GC and severe liver failure owing to multiple liver metastases. A 57-year-old man was admitted to Shimane Prefectural Central Hospital (Izumo, Japan) with a 2-week history of appetite loss and jaundice. An upper gastrointestinal endoscopy revealed advanced GC (type IV). Computed tomography examination confirmed wall thickening of the gastric pylorus and the presence of multiple liver metastases. A gastric mucosal biopsy confirmed the diagnosis of HER2-positive gastric adenocarcinoma. S-1 + cisplatin chemotherapy was initiated but had to be halted due to the rapid deterioration in liver function, ultimately leading to acute liver failure. The patient was discharged from the hospital under palliative care. The patient was referred to Shimane University Hospital (Izumo, Japan) for a second consultation. Upon admission, the patient presented with severe liver failure, a Child-Pugh score of 10 (Class C), elevated total bilirubin levels of 13.9 mg/dl (normal range: