Luo WH, Li SJ, Wang XF. Response of cholangiocarcinoma with epigastric metastasis to lenvatinib plus sintilimab: A case report and review of literature. World J Gastrointest Oncol 2023; 15(11): 2033-2040 [PMID: 38077645 DOI: 10.4251/wjgo.v15.i11.2033]
Corresponding Author of This Article
Xue-Feng Wang, MD, Associate Chief Physician, Doctor, The Second Department of Hepatobiliary Surgery, Yantai Yuhuangding Hospital, No. 20 Yuhuangding East Road, Zhifu District, Yantai 264000, Shandong Province, China. seasonslo@126.com
Research Domain of This Article
Oncology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Oncol. Nov 15, 2023; 15(11): 2033-2040 Published online Nov 15, 2023. 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, Shao-Jun Li, Xue-Feng Wang
Wen-Hui Luo, Shao-Jun Li, Xue-Feng Wang, The Second Department of Hepatobiliary Surgery, Yantai Yuhuangding Hospital, Yantai 264000, Shandong Province, China
Co-first authors: Wen-Hui Luo and Shao-Jun Li.
Author contributions: Li SJ provided insights into the direction of this study and assisted in the writing. For example, Li SJ and two other authors proposed at the beginning of the article that liver is an immunological preferential organ with strong immune tolerance, which may affect the development of metastatic tumors. During the writing process, Li SJ collected images, such as Figure 1 for magnetic resonance imaging images of patients before surgery, Figure 2 for baseline magnetic resonance imaging images before targeted immunotherapy, and Figure 4 for magnetic resonance imaging images of different tumor sites after treatment, to find out typical and clear pictures, and labeled typical lesions in the figures at each stage. Additionally, he provided necessary help for literature search, such as finding new articles on targeted immunization of cholangiocarcinoma. After the completion of the writting, the co-first authors reviewed the paper and corrected language logic problems. When looking for a journal to submit our study, we have sought for the opinions of Li SJ and we all think it is appropriate to submit our article to the World Journal of Gastrointestinal Oncology.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xue-Feng Wang, MD, Associate Chief Physician, Doctor, The Second Department of Hepatobiliary Surgery, Yantai Yuhuangding Hospital, No. 20 Yuhuangding East Road, Zhifu District, Yantai 264000, Shandong Province, China. seasonslo@126.com
Received: July 6, 2023 Peer-review started: July 6, 2023 First decision: September 5, 2023 Revised: September 15, 2023 Accepted: September 28, 2023 Article in press: September 28, 2023 Published online: November 15, 2023 Processing time: 132 Days and 6.6 Hours
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.
Core Tip: Cholangiocarcinoma (CCA) is a highly lethal hepatobiliary neoplasm. This report presents a case with advanced CCA who received immunotherapy, revealing differences in treatment responses between intrahepatic vs. extrahepatic epigastric metastatic sites. This hitherto unreported phenomenon prompted us to investigate the differential outcomes of these metastatic patterns following treatment with lenvatinib combined with sintilimab, culminating in a summary report elucidating potential underlying mechanisms.
