Published online Nov 15, 2023. doi: 10.4251/wjgo.v15.i11.2033
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
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.
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.
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.