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Case Reports
. 2023 Nov 15;15(11):2033-2040.
doi: 10.4251/wjgo.v15.i11.2033.

Response of cholangiocarcinoma with epigastric metastasis to lenvatinib plus sintilimab: A case report and review of literature

Wen-Hui Luo  1 , Shao-Jun Li  1 , Xue-Feng Wang  2
Affiliations
Case Reports

Response of cholangiocarcinoma with epigastric metastasis to lenvatinib plus sintilimab: A case report and review of literature

Wen-Hui Luo et al. World J Gastrointest Oncol. .

Abstract

Background: Cholangiocarcinoma (CCA) poses a significant clinical challenge due to its low radical resection rate and a propensity for high postoperative recurrence, resulting in a poor dismal. Although the combination of targeted therapy and immunotherapy has demonstrated notable efficacy in several solid tumors recently, however, its application in CCA remains underexplored and poorly documented.

Case summary: This case report describes a patient diagnosed with stage IV CCA, accompanied by liver and abdominal wall metastases, who underwent palliative surgery. Subsequently, the patient received two cycles of treatment combining lenvatinib with sintilimab, which resulted in a reduction in abdominal wall metastasis, while intrahepatic metastasis displayed progression. This unexpected observation illustrates different responses of intrahepatic and extrahepatic metastases to the same therapy.

Conclusion: Lenvatinib combined with sintilimab shows promise as a potential treatment strategy for advanced CCA. Genetic testing for related driver and/or passenger mutations, as well as an analysis of tumor immune microenvironment analysis, is crucial for optimizing drug combinations and eventually addressing the issue of non-response in specific metastatic sites.

Keywords: Case report; Cholangiocarcinoma; Epigastric metastasis; Immune-checkpoint-inhibitor; Immunotherapy; Lenvatinib; Sintilimab.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1
The first admission was hepatobiliary enhanced magnetic resonance imaging. A: Sagittal images shows carcinoma in the middle and lower segment of the common bile duct (orange arrow); B: Diffusion-weighted imaging images shows carcinoma size of 1.1 cm (orange circle); C: Retroperitoneal enlarged lymph nodes size of 1.5 cm (orange circle).
Figure 2
Figure 2
Baseline hepatobiliary enhanced magnetic resonance imaging before targeted immunotherapy. A: Right epigastric metastases size of 2 cm × 1.9 cm (orange circle); B: Liver metastases in S5 segment size of 1.3 cm × 1.2 cm (blue circle); C: Left lateral lobe of the livermetastasis size of 0.5 cm × 0.4 cm (blue circle); D: Carcinoma in the middle and lower segment of the common bile duct size of 1.1 cm (orange circle); E: Retroperitoneal enlarged lymph nodes size of 1.3 cm (orange circle).
Figure 3
Figure 3
Pathological report adenocarcinoma infiltrates hepatic encephalopathy (200 ×).
Figure 4
Figure 4
Hepatobiliary enhanced magnetic resonance imaging after two cycles of targeted immunotherapy. A: Right epigastric metastases size of 0.4 cm × 0.5 cm (orange circle); B: Liver metastases in S5 segment size of 1.8 cm × 1.7 cm (blue circle); C: Left lateral lobe of the livermetastasis size of 0.9 cm × 0.9 cm (blue circle); D: Carcinoma in the middle and lower segment of the common bile duct size of 1.1 cm (orange circle); E: Retroperitoneal enlarged lymph nodes size of 1.3 cm (orange circle).
Figure 5
Figure 5
Timeline of the case report. CT: Computed tomography.
See this image and copyright information in PMC

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