Long-Term Response to Gemcitabine, Cisplatin, and Nab-Paclitaxel Followed by Maintenance Therapy for Advanced Gallbladder Cancer: A Case Report and Literature Review

Abstract

Background: Gallbladder cancer (GBC) is the most common and devastating tumor type of biliary tract cancer (BTC) with poor outcomes. A new combined regimen of gemcitabine, cisplatin, plus nab-paclitaxel is currently considered an effective option for patients with advanced BTC following the results of a phase II trial. In addition, maintenance therapy after first-line treatment has been shown to improve disease control rate of various solid tumors but has not been evaluated for GBC patients. The scenario we report herein is of a metastatic GBC patient treated with the triple-drug regimen followed by maintenance therapy with capecitabine or S-1, who achieved a long-term survival benefit.

Case presentation: A 68-year-old man was diagnosed with gallbladder adenocarcinoma with liver, supra-diaphragmatic, and abdominal lymph node metastases (cT3N2M1, stage IVB). Partial response (PR) was achieved after five cycles of gemcitabine and cisplatin chemotherapy. A further three cycles of nab-paclitaxel plus gemcitabine-cisplatin regimen yielded a complete response of all tumor lesions. Subsequent administration of maintenance therapy with capecitabine followed by S-1 achieved a disease-free survival of 15 months for the patient. Moreover, the patient remained responsive to this triple-drug regimen when the disease progressed, achieving PR after two cycles of chemotherapy. Overall, the treatment regimens were well tolerated with no grade 3 or higher adverse effects occurring. Notably, the serum carbohydrate antigen 199 (CA199) levels were closely related to the treatment response and increased before the lesions were found on PET-CT during follow-up.

Conclusion: Our findings suggested that adding nab-paclitaxel into gemcitabine-cisplatin regimen may result in a favorable efficacy in patients with advanced GBC. Further maintenance therapy with capecitabine or S-1 after first-line therapy appeared to be a reasonable option for these patients, and it is valuable to monitor CA199 levels during treatment and follow-up.

Keywords: case report; complete response; gallbladder cancer; maintenance therapy; nab-paclitaxel.

Figure 1

Imaging scans, pathological findings, and timeline with relevant data from the episode of care. HE staining of the postoperative pathological specimen indicated adenocarcinoma (scale bars represent 100 µm). Before first-line treatment, representative PET-CT images were shown. Regular revision computed tomography (CT) was used to assess treatment efficacy during first-line treatment. After five cycles of gemcitabine and cisplatin chemotherapy followed by three cycles of nab-paclitaxel in combination with gemcitabine and cisplatin chemotherapy, representative PET-CT images were shown. No lesions were detected by PET-CT, when an elevated CA199 was tested. When the patient began to experience progressively worsening abdominal pain and an abnormal increase in CA199, PET-CT was performed and representative images were shown. CT scan was performed after two cycles of nab-paclitaxel plus gemcitabine and cisplatin chemotherapy, and showed a PR of all tumor lesions. Rx, treatment; PET-CT, positron emission tomography–computed tomography; CT computed tomography; CA199, cancer antigen 199; PR partial response; CR, complete response; G, gemcitabine; A, nab-paclitaxel; P, cisplatin.

Figure 2

Changes in CA199 levels during the treatment and follow-up. The CA199 tumor marker was measured in patients’ blood at periodic intervals throughout the clinical course and annotated with date, therapeutic approach, and treatment efficacy. CA199, cancer antigen 199; CR complete response; PR partial response.

Figure 3

Immunohistochemical results from post-operative pathological tissues of the patient. The results showed higher number of CD4⁺ and CD8⁺ T cells and the lower number of FOXP3⁺ Tregs and PD-(L)1 expression in tumor microenvironment. Scale bars represent 100 µm (20 µm in the inset images). FOXP3, Forkhead box P3; PD-L1, programmed cell death-ligand 1.