The administration of chemotherapy to cancer patients with organ dysfunction raises concerns regarding its safety. The safety profile of patients with organ dysfunction due to rare diseases treated with chemotherapy plus immune checkpoint inhibitor is limited. Fibrinogen storage disease (FSD) is a rare disease that causes liver dysfunction through endoplasmic reticulum stress response due to abnormal accumulation of fibrinogen in the endoplasmic reticulum of hepatocytes. Although chemotherapy plus nivolumab is recommended as a standard first-line treatment for patients with advanced gastric cancer (AGC), its safety profile for patients with FSD is rarely available. In this study, an 80-year-old male with gastric cancer with positive lavage cytology was scheduled to receive palliative chemotherapy. This case had liver dysfunction of unknown cause, and a liver biopsy was performed. Histopathological findings revealed a diagnosis of type II/III fibrinogen inclusion based on morphology and immunohistochemistry. Liver function was recovered by administering ursodeoxycholic acid. Therefore, the combination chemotherapy of S-1, oxaliplatin, with nivolumab as palliative chemotherapy was initiated. The case responded well to chemotherapy and achieved conversion surgery without worsening of liver function. We report a case of AGC with fibrinogen inclusion complication where chemotherapy was safely administered with a good outcome. The combination therapy of cytotoxic drugs and immune checkpoint inhibitors may be safely and effectively administered to such patients.

中文翻译：

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晚期胃癌并发纤维蛋白原贮积病的罕见病例采用化疗加免疫检查点抑制剂治疗：病例报告。

对器官功能障碍的癌症患者进行化疗引起了对其安全性的担忧。由于罕见疾病而导致器官功能障碍的患者接受化疗加免疫检查点抑制剂治疗的安全性有限。纤维蛋白原贮积病（FSD）是一种罕见疾病，由于肝细胞内质网中纤维蛋白原异常积累，通过内质网应激反应导致肝功能障碍。尽管化疗联合纳武利尤单抗被推荐作为晚期胃癌 (AGC) 患者的标准一线治疗，但其对于 FSD 患者的安全性却鲜为人知。在这项研究中，一名 80 岁的胃癌男性，灌洗细胞学检查呈阳性，计划接受姑息化疗。该病例存在不明原因的肝功能障碍，并进行了肝活检。根据形态学和免疫组织化学，组织病理学结果显示 II/III 型纤维蛋白原包涵体的诊断。通过给予熊去氧胆酸恢复肝功能。因此，开始S-1、奥沙利铂联合纳武单抗作为姑息化疗。该病例对化疗反应良好，并在肝功能未恶化的情况下完成了转化手术。我们报告了一例伴有纤维蛋白原包涵并发症的 AGC 病例，该病例安全地进行了化疗并取得了良好的结果。细胞毒性药物和免疫检查点抑制剂的联合治疗可以安全有效地施用于此类患者。