Abudalou Mohammad, Vega Eduardo A, Kondratiev Svetlana, Conrad Claudius, Kozyreva Olga
Internal Medicine, St. Elizabeth's Medical Center, Boston, USA.
Surgical Oncology, St. Elizabeth's Medical Center, Boston, USA.
Cureus. 2021 Dec 5;13(12):e20187. doi: 10.7759/cureus.20187. eCollection 2021 Dec.
Intrahepatic cholangiocarcinoma (ICC) is an aggressive biliary tract cancer (BTC) with distinct anatomic, molecular, and clinical characteristics. Over the last 10-20 years, ICC has become the focus of increasing concern largely due to its rising incidence and high mortality rates in various parts of the world, including the United States. Surgery is the only potentially curative treatment option for ICC; however, recurrence rate is high, and prognosis is poor in patients with recurrent disease. The chemotherapy regimen of gemcitabine-cisplatin (GemCis) is still the standard of care for patients with unresectable metastatic ICC. There is limited data regarding pathologic ICC response to palliatively intentioned systemic treatment. Here, we report a case of a 47-year-old Caucasian male with metastatic ICC microsatellite stable (MSS) and TMB 49 mutation per megabase who achieved complete pathological response with sequential GemCis/nab-paclitaxel and pembrolizumab. This case highlights the effect of sequential neoadjuvant chemoimmunotherapy in a patient with high tumor mutational burden (TMB-H) ICC, emphasizing the importance of molecular testing, which provides valuable information that can be used in clinical practice to better select targeted chemotherapy regimens.
肝内胆管癌（ICC）是一种侵袭性胆管癌（BTC），具有独特的解剖、分子和临床特征。在过去10至20年中，ICC已成为日益受到关注的焦点，这主要是由于其在包括美国在内的世界各地发病率不断上升且死亡率很高。手术是ICC唯一可能治愈的治疗选择；然而，复发率很高，复发患者的预后很差。吉西他滨-顺铂（GemCis）化疗方案仍然是不可切除转移性ICC患者的标准治疗方案。关于姑息性全身治疗的病理性ICC反应的数据有限。在此，我们报告一例47岁的白种男性转移性ICC患者，微卫星稳定（MSS）且肿瘤突变负荷（TMB）为每兆碱基49个突变，该患者通过序贯GemCis/白蛋白结合型紫杉醇和帕博利珠单抗实现了完全病理缓解。该病例突出了序贯新辅助化疗免疫疗法在高肿瘤突变负荷（TMB-H）ICC患者中的效果，强调了分子检测的重要性，其提供了可用于临床实践以更好地选择靶向化疗方案的有价值信息。
