Liu Ting, Li Qing, Zhang Wenjie, Zhu Qing
Department of Biotherapy, Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
Cancer Center, West China Hospital, Sichuan University, Chengdu, China.
Front Oncol. 2021 Oct 5;11:733955. doi: 10.3389/fonc.2021.733955. eCollection 2021.
Gallbladder cancer (GBC) is the most common and devastating tumor type of biliary tract cancer (BTC) with poor outcomes. A new combined regimen of gemcitabine, cisplatin, plus nab-paclitaxel is currently considered an effective option for patients with advanced BTC following the results of a phase II trial. In addition, maintenance therapy after first-line treatment has been shown to improve disease control rate of various solid tumors but has not been evaluated for GBC patients. The scenario we report herein is of a metastatic GBC patient treated with the triple-drug regimen followed by maintenance therapy with capecitabine or S-1, who achieved a long-term survival benefit.
A 68-year-old man was diagnosed with gallbladder adenocarcinoma with liver, supra-diaphragmatic, and abdominal lymph node metastases (cT3N2M1, stage IVB). Partial response (PR) was achieved after five cycles of gemcitabine and cisplatin chemotherapy. A further three cycles of nab-paclitaxel plus gemcitabine-cisplatin regimen yielded a complete response of all tumor lesions. Subsequent administration of maintenance therapy with capecitabine followed by S-1 achieved a disease-free survival of 15 months for the patient. Moreover, the patient remained responsive to this triple-drug regimen when the disease progressed, achieving PR after two cycles of chemotherapy. Overall, the treatment regimens were well tolerated with no grade 3 or higher adverse effects occurring. Notably, the serum carbohydrate antigen 199 (CA199) levels were closely related to the treatment response and increased before the lesions were found on PET-CT during follow-up.
Our findings suggested that adding nab-paclitaxel into gemcitabine-cisplatin regimen may result in a favorable efficacy in patients with advanced GBC. Further maintenance therapy with capecitabine or S-1 after first-line therapy appeared to be a reasonable option for these patients, and it is valuable to monitor CA199 levels during treatment and follow-up.
胆囊癌（GBC）是胆道癌（BTC）中最常见且危害极大的肿瘤类型，预后较差。根据一项II期试验结果，吉西他滨、顺铂联合纳米白蛋白结合型紫杉醇的新联合方案目前被认为是晚期BTC患者的有效选择。此外，一线治疗后的维持治疗已被证明可提高各种实体瘤的疾病控制率，但尚未在GBC患者中进行评估。我们在此报告的病例是一名转移性GBC患者，接受三联药物方案治疗后，再用卡培他滨或S-1进行维持治疗，获得了长期生存益处。
一名68岁男性被诊断为胆囊腺癌，伴有肝、膈上及腹部淋巴结转移（cT3N2M1，IVB期）。吉西他滨和顺铂化疗五个周期后达到部分缓解（PR）。纳米白蛋白结合型紫杉醇联合吉西他滨-顺铂方案再进行三个周期治疗后，所有肿瘤病灶完全缓解。随后用卡培他滨继以S-1进行维持治疗，该患者无病生存期达15个月。此外，疾病进展时该患者对这种三联药物方案仍有反应，化疗两个周期后达到PR。总体而言，治疗方案耐受性良好，未出现3级或更高等级的不良反应。值得注意的是，血清糖类抗原199（CA199）水平与治疗反应密切相关，随访期间在PET-CT发现病灶之前升高。
我们的研究结果表明，在吉西他滨-顺铂方案中加入纳米白蛋白结合型紫杉醇可能对晚期GBC患者产生良好疗效。一线治疗后用卡培他滨或S-1进行进一步维持治疗似乎是这些患者的合理选择，在治疗和随访期间监测CA199水平很有价值。
