Shinke Go, Takeda Yutaka, Ohmura Yoshiaki, Kinoshita Mitsuru, Katsura Yoshiteru, Aoyama Shu, Kihara Yukari, Yanagisawa Kiminori, Katsuyama Shinsuke, Ikeshima Ryo, Hiraki Masayuki, Sugimura Keijiro, Masuzawa Toru, Hata Taishi, Murata Kohei
Dept. of Surgery, Kansai Rosai Hospital.
Gan To Kagaku Ryoho. 2023 Dec;50(13):1875-1877.
Tumor mutation burden(TMB)-High is known to potentially elicit a favorable response to immune checkpoint inhibitors. In this report, we present a case of recurrent hilar cholangiocarcinoma with TMB-High, in which we performed comprehensive treatment including immune checkpoint inhibitor pembrolizumab. The patient was a 58-year-old male diagnosed with hilar cholangiocarcinoma who underwent extended right hepatectomy, caudate lobe resection, bile duct excision, and bile duct reconstruction. Postoperatively, peritoneal seeding recurrence and liver metastasis were observed, indicating TMB-High. Therefore, pembrolizumab therapy was administered. The tumor marker CA19-9 significantly decreased, and the peritoneal seeding and liver metastatic lesions disappeared on imaging. In this case, we experienced the use of pembrolizumab monotherapy for TMB-High recurrent bile duct cancer with early postoperative peritoneal seeding recurrence. Further accumulation of cases is needed, but pembrolizumab monotherapy holds promise as a treatment option for TMB-High bile duct cancer at the hepatic hilum.
肿瘤突变负荷（TMB）高已知可能对免疫检查点抑制剂产生良好反应。在本报告中，我们展示了一例TMB高的复发性肝门胆管癌病例，在此病例中我们进行了包括免疫检查点抑制剂帕博利珠单抗在内的综合治疗。该患者为一名58岁男性，被诊断为肝门胆管癌，接受了扩大右肝切除术、尾状叶切除术、胆管切除术和胆管重建术。术后观察到腹膜种植转移和肝转移，提示TMB高。因此，给予了帕博利珠单抗治疗。肿瘤标志物CA19-9显著下降，影像学检查显示腹膜种植转移和肝转移病灶消失。在本病例中，我们尝试将帕博利珠单抗单药用于术后早期出现腹膜种植转移复发的TMB高复发性胆管癌。虽然还需要更多病例的积累，但帕博利珠单抗单药有望成为肝门部TMB高胆管癌的一种治疗选择。
