Deiana Chiara, Palloni Andrea, Mosca Mirta, Vasuri Francesco, Chillotti Stefano, Tavolari Simona, De Biase Dario, Frega Giorgio, Giovannetti Elisa, Brandi Giovanni
Medical Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
Front Oncol. 2025 Mar 18;15:1459705. doi: 10.3389/fonc.2025.1459705. eCollection 2025.
Combined hepatocellular-cholangiocarcinoma (cHCC-CCA) is a rare primary liver cancer, with intermediate biological characteristics between hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA). Given its rarity and the lack of robust data from randomized clinical trials, treatment is not standardized, and the choice on how to best manage the disease is left to the expertise of each institution. In the metastatic setting, given the more aggressive behavior of the CCA component, the usual approach is to start treatment with chemotherapy instead of tyrosine-kinase inhibitors (TKIs). We present a case report on a Caucasian male with a poor response to first-line treatment with chemotherapy directed against CCA, but with an excellent and long overall survival (OS) of 71 months, thanks to HCC-directed treatment with TKI. Here, we highlight the difficulty in selecting an appropriate treatment upfront for this rare cancer and we also discuss future perspectives regarding predictive tools, especially considering the recent genomic analysis of cHCC-CCA, and regarding the potential use of immunotherapy and target therapy.
肝内胆管癌合并肝细胞癌（cHCC-CCA）是一种罕见的原发性肝癌，具有介于肝细胞癌（HCC）和胆管癌（CCA）之间的中间生物学特征。鉴于其罕见性以及缺乏来自随机临床试验的有力数据，治疗并不规范，如何最佳管理该疾病的选择留给了每个机构的专业知识。在转移情况下，鉴于CCA成分的侵袭性更强，通常的方法是开始化疗而不是酪氨酸激酶抑制剂（TKIs）治疗。我们报告了一例高加索男性病例，该患者对针对CCA的一线化疗反应不佳，但由于采用了针对HCC的TKI治疗，总生存期（OS）长达71个月，效果极佳。在此，我们强调了为这种罕见癌症预先选择合适治疗方法的困难，并且我们还讨论了关于预测工具的未来前景，特别是考虑到最近对cHCC-CCA的基因组分析，以及免疫疗法和靶向疗法的潜在应用。
