HER2 阳性晚期肝内胆管癌患者接受吡咯替尼联合帕博利珠单抗和仑伐替尼治疗的临床疗效：病例报告。

Clinical response to adding pyrotinib to pembrolizumab and lenvatinib for HER2-positive advanced intrahepatic cholangiocarcinoma: a case report.

机构信息

Department of Liver Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.

Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.

出版信息

World J Surg Oncol. 2023 Mar 27;21(1):108. doi: 10.1186/s12957-023-02983-1.

BACKGROUND

Intrahepatic cholangiocarcinoma (ICC) is a highly lethal hepatobiliary cancer, and very few patients can undergo surgery. The prognosis of advanced ICC is poor, especially in patients who progress after first-line chemotherapy, with a median overall survival of less than 10 months.

CASE PRESENTATION

A 64-year-old male was diagnosed with advanced intrahepatic cholangiocarcinoma with ERBB2 (HER2) 3 + amplification determined by tissue-based testing and confirmed by next-generation sequencing. The patient was treated with pyrotinib added to pembrolizumab and lenvatinib after progressing with pyrotinib and tegafur and responded very well with regression of the tumor on imaging as well as normalization of tumor marker levels without serious adverse events. PET-CT after 6 months of treatment showed a partial response. The progression-free survival with second-line treatment was 17 months. For the third line of therapy, lenvatinib and pembrolizumab were used in combination with bevacizumab. Currently, he has had stable disease for approximately 6 months during third-line treatment.

CONCLUSION

Adding pyrotinib to pembrolizumab and lenvatinib may represent a promising strategy for advanced ICC patients who have high levels of HER2.

背景

肝内胆管癌（ICC）是一种高度致命的肝胆癌，只有极少数患者可以接受手术治疗。晚期 ICC 的预后很差，尤其是在一线化疗后进展的患者中，中位总生存期不到 10 个月。

病例介绍

一名 64 岁男性被诊断为晚期肝内胆管癌，组织学检测显示 ERBB2（HER2）3+扩增，经下一代测序证实。该患者在接受吡咯替尼和替吉奥治疗进展后，接受了吡咯替尼联合帕博利珠单抗和仑伐替尼治疗，疗效非常好，肿瘤在影像学上消退，肿瘤标志物水平正常，没有严重的不良事件。治疗 6 个月后的 PET-CT 显示部分缓解。二线治疗的无进展生存期为 17 个月。对于三线治疗，仑伐替尼和帕博利珠单抗联合贝伐珠单抗。目前，他在三线治疗期间病情稳定约 6 个月。