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病例报告:不可切除性肝内胆管癌的转化治疗:1例使用替雷利珠单抗、仑伐替尼和GEMOX方案的病例

Case report: Translational treatment of unresectable intrahepatic cholangiocarcinoma: Tislelizumab, Lenvatinib, and GEMOX in one case.

作者信息

Zhang He-Wei, Yu Hai-Bo

机构信息

Department of Hepatobiliary and Pancreatic Surgery, The Dingli Clinical Institute of Wenzhou Medical University (Wenzhou Central Hospital), Wenzhou, Zhejiang, China.

出版信息

Front Oncol. 2024 Jul 15;14:1428370. doi: 10.3389/fonc.2024.1428370. eCollection 2024.

Abstract

BACKGROUND

Intrahepatic cholangiocellular carcinoma (ICC) is one of the most common invasive malignancies. Currently, ICC is treated with radical surgical resection. However, the majority of patients are diagnosed at an advanced stage, making surgery ineligible for them.

CASE PRESENTATION

We present a case of advanced ICC, which could not undergo radical surgery due to tumor invasion of liver blood vessels. The gemcitabine and oxaliplatin (GEMOX) regimen combined with Tislelizumab immunotherapy and Lenvatinib targeted therapy for 8 cycles resulted in significant tumor shrinkage significantly and the vascular invasion disappeared. CA19-9 levels were reduced to normal levels. Partial remission and successful tumor transformation were achieved. The patient underwent a successful radical surgical resection, including cholecystectomy, resection of liver segments IV, V, and VIII, as well as a regional lymphatic dissection procedure, resulting in complete pathological remission.

CONCLUSION

Tumor-free surgical margins (R0) resection of patients with advanced ICC after combination of immune, targeted and chemotherapy is rare, and there are almost no cases of complete postoperative remission. The GEMOX regimen in combination with Tislelizumab and Lenvatinib has a good antitumor efficacy and safety profile, and may be a feasible and safe translational treatment option for advanced ICC.

摘要

背景

肝内胆管细胞癌(ICC)是最常见的侵袭性恶性肿瘤之一。目前,ICC采用根治性手术切除治疗。然而,大多数患者在晚期才被诊断出来,因此无法进行手术。

病例介绍

我们报告一例晚期ICC病例,由于肿瘤侵犯肝血管,无法进行根治性手术。吉西他滨和奥沙利铂(GEMOX)方案联合替雷利珠单抗免疫治疗和仑伐替尼靶向治疗8个周期后,肿瘤显著缩小,血管侵犯消失。CA19-9水平降至正常水平。实现了部分缓解和成功的肿瘤转化。患者成功接受了根治性手术切除,包括胆囊切除术、肝IV、V和VIII段切除术以及区域淋巴结清扫术,实现了完全病理缓解。

结论

晚期ICC患者在免疫、靶向和化疗联合治疗后实现无瘤手术切缘(R0)切除的情况罕见,术后完全缓解的病例几乎没有。GEMOX方案联合替雷利珠单抗和仑伐替尼具有良好的抗肿瘤疗效和安全性,可能是晚期ICC一种可行且安全的转化治疗选择。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0c6d/11284616/ddd4a937cec9/fonc-14-1428370-g001.jpg

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