Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2023 May 24:14:1124482.
doi: 10.3389/fimmu.2023.1124482. eCollection 2023.

Case Report: Persistent response to combination therapy of pemigatinib, chemotherapy, and immune checkpoint inhibitor in a patient with advanced intrahepatic cholangiocarcinoma

Zhuochao Zhang  1   2 , Gaofei Wang  3 , Lei Du  4 , Jie Zhao  1 , Lichao Pan  1   2 , Gong Zhang  1   2   5 , Fei Wang  1   2 , Rong Liu  1   2
Affiliations
Case Reports

Case Report: Persistent response to combination therapy of pemigatinib, chemotherapy, and immune checkpoint inhibitor in a patient with advanced intrahepatic cholangiocarcinoma

Zhuochao Zhang et al. Front Immunol. .

Abstract

Patients with advanced intrahepatic cholangiocarcinoma (iCCA) often have a poor prognosis. Recent advancements in targeted molecular therapy and immunotherapy have been made. Herein, we report a case of advanced iCCA treated with a combination of pemigatinib (a selective FGFR inhibitor), chemotherapy, and an immune checkpoint inhibitor. A 34-year-old female was diagnosed with advanced iCCA with multiple liver masses and metastases in the peritoneum and lymph nodes. Next-generation sequencing (NGS) identified the genetic mutations. An FGFR2-BICC1 gene fusion was found in this patient. The patient was treated with pemigatinib in combination with pembrolizumab plus systemic gemcitabine and oxaliplatin. After 9 cycles of the combination therapy, the patient achieved a partial response, complete metabolic response, and normalization of tumor markers. Sequentially, the patient received pemigatinib and pembrolizumab for 3 months. Due to the elevated tumor biomarker, she is currently receiving chemotherapy, pemigatinib, and pembrolizumab treatment again. She regained an excellent physical status after 16 months of treatment. To the best of our knowledge, this was the first reported case of advanced iCCA successfully treated with a combination of pemigatinib, chemotherapy, and ICIs as a first-line regimen. This treatment combination may be effective and safe in the advanced iCCA.

Keywords: FGFR inhibitors; advanced intrahepatic cholangiocarcinoma; combined therapy; immune checkpoint inhibitor; pemigatinib.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Hematoxylin-eosin (H&E) staining and immunohistochemical evaluation of the tissue obtained using needle biopsy (10x). Pathological images show (A) (H&E) staining, (B) positive staining for CK18, (C) positive staining for CK19, (D) positive staining for PD-1, (E) positive staining for PD-L1(10% positive), (F) negative staining for CA125, (G) negative staining for hepatocytes, (H) negative sating for ER, and (I) H&E staining of tumor cells from the ascitic fluid (0.5x).
Figure 2
Figure 2
The PET-CT images for evaluating the treatment response. The metabolic activity change is noticeable in the masses located in the right liver (A), left liver (B), left cervical lymph node (C), retroperitoneal nodes (D), and omentum and ovary (E) (2021-10 is the baseline).
Figure 3
Figure 3
The MRI scans during the systemic treatment. (A) Upper-row images indicate the maximum diameter of the lesion located in the right liver; Lower row images denote the maximum diameter of the lesion located in the left liver. Arrows in the figures indicate the position of the lesions. (B) The sum of tumor diameters.
Figure 4
Figure 4
Diagram depicting the dynamic changes of CA125 (A), phosphorous level (B), and TPOA/TGA (C) over time, after the onset of systemic therapy. (D) The timeline of the treatment protocol. iCCA, intrahepatic cholangiocarcinoma; NGS, next-generation sequencing; PR, partial response.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Brindley PJ, Bachini M, Ilyas SI, Khan SA, Loukas A, Sirica AE, et al. . Cholangiocarcinoma. Nat Rev Dis Primers (2021) 7:65. doi: 10.1038/s41572-021-00300-2 - DOI - PMC - PubMed
    1. Banales JM, Marin J, Lamarca A, Rodrigues PM, Khan SA, Roberts LR, et al. . Cholangiocarcinoma 2020: the next horizon in mechanisms and management. Nat Rev Gastroenterol Hepatol (2020) 17:557–88. doi: 10.1038/s41575-020-0310-z - DOI - PMC - PubMed
    1. Ruzzenente A, Conci S, Valdegamberi A, Pedrazzani C, Guglielmi A. Role of surgery in the treatment of intrahepatic cholangiocarcinoma. Eur Rev Med Pharmacol Sci (2015) 19:2892–900. - PubMed
    1. Yonemoto N, Furuse J, Okusaka T, Yamao K, Funakoshi A, Ohkawa S, et al. . A multi-center retrospective analysis of survival benefits of chemotherapy for unresectable biliary tract cancer. Jpn J Clin Oncol (2007) 37:843–51. doi: 10.1093/jjco/hym116 - DOI - PubMed
    1. Valle J, Wasan H, Palmer DH, Cunningham D, Anthoney A, Maraveyas A, et al. . Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med (2010) 362:1273–81. doi: 10.1056/NEJMoa0908721 - DOI - PubMed

Publication types