CASE REPORT article
Front. Oncol.
Sec. Gastrointestinal Cancers: Gastric and Esophageal Cancers
Pathologic Complete Response to PRaG Therapy in an Elderly Patient with 1 Refractory Metastatic Gastric Cancer: A Case Report
Provisionally accepted
- Department of Radiotherapy, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Hepatoid adenocarcinoma of the stomach (HAS) is a rare histologic subtype of gastric 15 cancer with distinct pathological features and poor prognosis. Surgery and 16 chemotherapy remain the primary treatment modalities, but outcomes are generally 17 unsatisfactory. Radiotherapy can enhance tumor immunogenicity by releasing tumor 18 antigens, thereby promoting antitumor immune responses and potentiating the 19 efficacy of immune checkpoint inhibitors. We report a case of advanced HAS that 20 progressed after first-line treatment with chemotherapy, immunotherapy, and targeted 21 therapy. The patient subsequently received a combination of radiotherapy, 22 programmed cell death protein 1 (PD-1) blockade, and granulocyte-macrophage 23 colony-stimulating factor (GM-CSF)—termed PRaG therapy. The tumor 24 demonstrated significant shrinkage following PRaG treatment and ultimately achieved 25 pathologic complete response (pCR), with no serious adverse events aside from mild 26 abdominal pain (NRS score 2). This case suggests that PRaG therapy may represent a 27 promising therapeutic approach for patients with metastatic HAS.
Keywords: case report, Metastatic gastric cancer, Pathologic complete response (pCR), PRaG therapy, Refractory
Received: 16 Oct 2025; Accepted: 16 Dec 2025.
Copyright: © 2025 Lv, Yu, Pan, Fang, Zhong, Bai, Gao and Wei. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Zhuxin Wei
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