Administration of Nivolumab Plus FOLFOX Therapy - Case Report

Sep 23, 2026

Optimal chemotherapy dosing for patients undergoing hemodialysis remains unclear. A 65-year-old man with diabetic nephropathy received nivolumab plus modified FOLFOX6 for recurrent gastric cancer with liver metastases. Oxaliplatin dosing was reduced to 65 mg/m2, continuous infusion 5-fluorouracil was started at 2,000 mg/m2, and bolus administration was stopped. Nivolumab was not given, and dose adjustments or discontinuation were made based on general condition and blood tests during treatment. Standard chemotherapy for gastric cancer proved ineffective due to ascites and elevated CA125.

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Introduction

Case Report

doi: 10.2169/internalmedicine.5874-25 Intern Med 65: 1205-1209, 2026 [http://internmed.jp](http://internmed.jp) 【CASE REPORT】 | Administration of Nivolumab Plus FOLFOX Therapy to a Patient with Gastric Cancer Undergoing Hemodialysis | | | --- | --- | | Taichi Yoshida 1, Naoaki Kodama 1,2, Tomohiro Matsumoto 1, Daiki Taguchi 1, Kazuhiro Shimazu 1, Koji Fukuda 1 and Hiroyuki Shibata 1 | | | Abstract:
The optimal dose of chemotherapy for patients undergoing hemodialysis remains unclear. A 65-year-oldman with diabetic nephropathy was treated with nivolumab plus modified FOLFOX6 therapy for recurrent gastric cancer with liver metastases. Oxaliplatin was reduced to 65 mg/m2, continuous infusion of 5-fluorouracil was initiated at 2,000 mg/m2, and bolus administration was discontinued. No nivolumab was administrated. Dose modification and discontinuation were performed depending on the patient’s general condition and blood test during the treatment course. He received standard chemotherapy for gastric cancer; however, it was ineffective because of ascites and elevated CA125 levels.
Key words: hemodialysis, gastric cancer, FOLFOX, nivolumab, 5-fluorouracil, oxaliplatin
(Intern Med 65: 1205-1209, 2026)
(DOI: 10.2169/internalmedicine.5874-25) | | |
Introduction | temic chemotherapies. Traditionally, FOLFOX and CapeOX therapies in the first-line setting have been administered to patients with advanced GC (AGC) on HD (3, 4) . These regi- | | Hemodialysis (HD) is a form of renal replacement therapy | mens have been reported to be safely administered with | | for patients with end-stage kidney disease that removes | dose reduction. Recently, Nivolumab (Nivo) combined with | | metabolic waste and excess body water and replenishes | cytotoxic agents is considered a standard of care for patients | | body buffers to sustain life. According to the Japanese Soci- | with human epithelial growth factor receptor 2 (HER2) - | | ety of Dialysis Therapy Renal Data Registry, approximately | negative AGC (5, 6) . However, there are no reports of ad- | | 340,000 patients in Japan will receive chronic dialysis ther- | ministering a combination therapy of nivolumab and cyto- | | apy by the end of 2020 (1) . Chronic heart failure and infec- | toxic agents to patients on HD; therefore, the efficacy and | | tious diseases are the primary causes of death in patients on | safety of this regimen remain unclear. We herein report a | | HD, with malignant tumors being the third leading cause of | case of AGC treated with nivolumab plus FOLFOX during | | death (9.4%) . An increasing number of patients undergoing HD may receive chemotherapy for malignancy. However, its | HD. | | efficacy and safety have not been sufficiently verified, because almost all clinical trials have excluded patients on |
Case Report | | HD. If chemotherapy is considered, the dose should be | The patient was a 65-year-old man with diabetic nephro- | | modified based on the patient’s condition. | pathy who had undergone HD three times a week since | | Gastric cancer (GC) is the fifth most common cancer and | 2020. In April 2022, he was diagnosed with GC and derma- | | the fourth leading cause of cancer-related death world- | tofibrosarcoma protuberans (DFSP) . The patient underwent | | wide (2) . Complete surgical or endoscopic resection is the | laparoscopic distal gastrectomy with D2 lymph node dissec- | | only curative treatment modality. Patients with locally advanced and metastatic disease are generally treated with sys- | tion for GC, which led to a diagnosis of stage 1A (pT1bN0 M0) in May 2022 . Histopathological examination revealed a | 1 Department of Clinical Oncology, Graduate School of Medicine, Akita University, Japan and 2 Department of Medical Oncology, Akita Red Cross Hospital, Japan Received: April 25, 2025; Accepted: July 29, 2025; Advance Publication by J-STAGE: September 18, 2025 Correspondence to Dr. Taichi Yoshida, [royalbbs@med.akita-u.

FAQs

Why is the optimal chemotherapy dose uncertain for hemodialysis patients?

The document states that the optimal dose of chemotherapy for patients undergoing hemodialysis remains unclear, largely because many clinical trials exclude patients on hemodialysis.

What regimen was used in the reported patient and how were doses modified?

The patient was treated with nivolumab plus modified FOLFOX6. Oxaliplatin was reduced to 65 mg/m2, continuous 5-fluorouracil infusion was initiated at 2,000 mg/m2, and bolus 5-fluorouracil was discontinued.

Why was nivolumab not administered in this case?

The abstract specifies that no nivolumab was administrated, with treatment modification and discontinuation performed according to the patient’s general condition and blood test results during the treatment course.

Sep 23, 2026

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