Osuga Takahiro, Miyanishi Koji, Ito Ryo, Tanaka Shingo, Hamaguchi Kota, Ohnuma Hiroyuki, Murase Kazuyuki, Takada Kohichi, Nagayama Minoru, Kimura Yasutoshi, Sugawara Taro, Sugita Shintaro, Takemasa Ichiro, Hasegawa Tadashi, Kato Junji
Department of Medical Oncology, Sapporo Medical University School of Medicine, Sapporo, Japan.
Department of Infection Control and Laboratory Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan.
Case Rep Oncol. 2022 Mar 29;15(1):318-325. doi: 10.1159/000523895. eCollection 2022 Jan-Apr.
A 77-year-old man was referred to our hospital because of a hepatic tumor. Blood biochemistry showed elevated serum alfa-fetoprotein, protein induced by vitamin K absence-II, and carbohydrate antigen 19-9 levels. Gd-EOB-DTPA-enhanced magnetic resonance imaging revealed a 95-mm-sized tumor in liver S7. The tumor showed heterogeneous hyperintensity in the arterial phase, slightly washed out from the portal vein phase, and hypointensity in the hepatocellular phase. Post-enlargement segmental resection was performed, and the pathological diagnosis was combined hepatocellular cholangiocarcinoma. Seven months after surgery, multiple liver tumors were found, and biopsy revealed combined hepatocellular-cholangiocarcinoma. Hepatic arterial infusion chemotherapy with cisplatin was initiated. However, the patient developed a pulmonary abscess, which was treated with antibiotics. He then underwent treatment with lenvatinib, 11 months after surgery. At 8 weeks follow-up, a complete response (according to the modified Response Evaluation Criteria in Solid Tumors [RECIST]) and a partial response (RECIST version 1.1) was noted. To the best of our knowledge, thus far, only a single case of lenvatinib treatment of unresectable mixed liver cancer has been reported. In that case, lenvatinib was used as a third-line treatment. The present report is the first to describe lenvatinib as a first-line therapy for unresectable combined hepatocellular-cholangiocarcinoma, which resulted in a meaningful response. This case provides useful insights into the choice of appropriate drug treatment in this disease in the absence of randomized controlled trials of drug treatment.
一名77岁男性因肝脏肿瘤转诊至我院。血液生化检查显示血清甲胎蛋白、维生素K缺乏诱导蛋白-II和糖类抗原19-9水平升高。钆塞酸二钠增强磁共振成像显示肝S7段有一个95毫米大小的肿瘤。该肿瘤在动脉期呈不均匀高信号，门静脉期略有廓清，肝细胞期呈低信号。进行了扩大肝段切除，病理诊断为混合性肝细胞胆管癌。术后7个月发现多发肝肿瘤，活检显示为混合性肝细胞胆管癌。开始使用顺铂进行肝动脉灌注化疗。然而，患者出现了肺脓肿，接受了抗生素治疗。术后11个月，他开始使用乐伐替尼治疗。在8周的随访中，观察到完全缓解（根据实体瘤改良疗效评价标准[RECIST]）和部分缓解（RECIST 1.1版）。据我们所知，迄今为止，仅报道了1例乐伐替尼治疗不可切除混合型肝癌的病例。在该病例中，乐伐替尼用作三线治疗。本报告首次描述了乐伐替尼作为不可切除混合性肝细胞胆管癌一线治疗药物，取得了有意义的疗效。在缺乏药物治疗随机对照试验的情况下，该病例为该病合适药物治疗的选择提供了有用的见解。
