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
. 2024 Dec 6;12(34):6721-6727.
doi: 10.12998/wjcc.v12.i34.6721.

Conversion surgery after gemcitabine and cisplatin plus durvalumab for advanced intrahepatic cholangiocarcinoma: A case report

Yu Igata  1 , Masashi Kudo  2 , Motohiro Kojima  3 , Shota Kami  1 , Keishiro Aoki  1 , Tomoyuki Satake  4 , Tatsushi Kobayashi  5 , Motokazu Sugimoto  1 , Shin Kobayashi  1 , Masaru Konishi  1 , Naoto Gotohda  1
Affiliations
Case Reports

Conversion surgery after gemcitabine and cisplatin plus durvalumab for advanced intrahepatic cholangiocarcinoma: A case report

Yu Igata et al. World J Clin Cases. .

Abstract

Background: The combination of immune checkpoint inhibitors and chemotherapy has shown promising results for the treatment of advanced biliary tract cancer (BTC). Based on the results of the TOPAZ-1 trial, a gemcitabine and cisplatin plus durvalumab (GCD) regimen was recently approved as first-line therapy for patients with advanced BTC. However, post-GCD conversion surgery has not been previously studied. Herein, we describe a case of advanced intrahepatic cholangiocarcinoma (ICC) successfully treated with radical surgery after GCD.

Case summary: A 65-year-old female diagnosed with advanced ICC with periductal infiltration into the hepatic hilum underwent eight cycles of GCD, followed by durvalumab maintenance treatment, with mild adverse events. Partial response was obtained. Subsequently, a conversion surgery with extended left hepatectomy and bile duct resection was performed. The resection margins were negative, and the pathological diagnosis was compatible with small duct type ICC. The patient remained disease-free for 8 months without adjuvant chemotherapy.

Conclusion: We describe the case of a patient who received successful conversion surgery after GCD treatment for advanced ICC.

Keywords: Case report; Conversion surgery; Immunotherapy; Intrahepatic cholangiocarcinoma; Small duct type.

PubMed Disclaimer

Conflict of interest statement

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

Figures

Figure 1
Figure 1
Dynamic computed tomography before and after eight courses of gemcitabine and cisplatin plus durvalumab. A: Advanced intrahepatic cholangiocarcinoma at the left hepatic duct; B: Tumor invasion of the umbilical portion of the portal vein; C: Suspected direct invasion of the extrahepatic bile duct. Bile duct wall enhancement continuous from the tumor extended to the anterior and posterior sectoral duct; D: Tumor showing remarkable shrinkage; E: Amelioration of the dilation of the intrahepatic bile duct; F: Bile duct wall enhancement showing significant decrease at the anterior and posterior sectoral duct. Yellow arrows indicate the following findings.
Figure 2
Figure 2
Changes in carcinoembryonic antigen and carbohydrate antigen 19-9 tumor marker levels and timeline of the gemcitabine and cisplatin plus durvalumab regimen. Numbers 1–8 indicate the treatment cycle. “D” indicates durvalumab maintenance therapy. CA 19-9: Carbohydrate antigen 19-9; CEA: Carcinoembryonic antigen.
Figure 3
Figure 3
Resection margins. A: Macroscopic findings of mass-forming and periductal-infiltrating intrahepatic cholangiocarcinoma; B: Hematoxylin and eosin (HE) staining of the preoperative biopsy specimen confirming the adenocarcinoma diagnosis; C and D: HE staining of the resected tumor. Small ductular-like structures lined by small nonmucinous cuboidal cells, characteristic findings in small duct type intrahepatic cholangiocarcinomas.
See this image and copyright information in PMC

References

    1. Oh DY, Ruth He A, Qin S, Chen LT, Okusaka T, Vogel A, Kim JW, Suksombooncharoen T, Ah Lee M, Kitano M, Burris H, Bouattour M, Tanasanvimon S, McNamara MG, Zaucha R, Avallone A, Tan B, Cundom J, Lee CK, Takahashi H, Ikeda M, Chen JS, Wang J, Makowsky M, Rokutanda N, He P, Kurland JF, Cohen G, Valle JW. Durvalumab plus Gemcitabine and Cisplatin in Advanced Biliary Tract Cancer. NEJM Evid. 2022;1:EVIDoa2200015. - PubMed
    1. Brierley JD, Gospodarowicz MK, Wittekind C. Skin Tumours. TNM Online. 2017
    1. National Cancer Institute. Common Terminology Criteria for Adverse Events (CTCAE) v5.0. CTEP 2017. Available from: https://ctep.cancer.gov/protocoldevelopment/electronic_applications/ctc..... [Accessed March 29, 2024]
    1. Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, Dancey J, Arbuck S, Gwyther S, Mooney M, Rubinstein L, Shankar L, Dodd L, Kaplan R, Lacombe D, Verweij J. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1) Eur J Cancer. 2009;45:228–247. - PubMed
    1. Nagtegaal ID, Odze RD, Klimstra D, Paradis V, Rugge M, Schirmacher P, Washington KM, Carneiro F, Cree IA WHO Classification of Tumours Editorial Board. The 2019 WHO classification of tumours of the digestive system. Histopathology. 2020;76:182–188. - PMC - PubMed

Publication types

LinkOut - more resources