Published online Oct 24, 2020. doi: 10.5306/wjco.v11.i10.844
Peer-review started: May 4, 2020
First decision: July 25, 2020
Revised: July 31, 2020
Accepted: September 8, 2020
Article in press: September 8, 2020
Published online: October 24, 2020
Cholangiocarcinomas are rare and very aggressive tumors. Most patients have advanced-stage or unresectable disease at presentation, and the systemic therapies have limited efficacy. Albumin-bound paclitaxel (nab-paclitaxel) is a solvent-free taxane that has been approved for the treatment of some cancers such as breast, non-small cell lung and pancreatic cancer, however it has not been applied to treat cholangiocarcinoma. We have both preclinical and clinical evidence of the efficacy of nab-paclitaxel in cholangiocarcinoma, yet no phase 3 trials have been made.
A 63-year-old man was diagnosed in December 2016 with stage III B intrahepatic cholangiocarcinoma. Surgery was performed, followed by adjuvant chemotherapy treatment with capecitabine and gemcitabine; although, the gemcitabine was suspended due to allergic reaction after two cycles. In April 2019, metastatic cholangiocarcinoma relapse was diagnosed, and a first-line treatment with FOLFOX scheme was started. Eight cycles were administered, producing an initial clinical improvement and decrease in blood tumor marker levels. Radiological and serological progression was noted in September 2019. As a second-line treatment, FOLFIRI was not recommended due to risk of worsening the patient’s tumor-related diarrhea. A combination therapy with gemcitabine was not feasible, as the patient had previously suffered from an allergic reaction to this treatment. We decided to use nab-paclitaxel as a second-line treatment, and four cycles were administered. Both clinical and serological responses were observed, and a radiological mixed response was also noted.
Advanced cholangiocarcinoma could be treated with nab-paclitaxel monotherapy, which should be studied in combination with other types of treatment (chemotherapy, fibroblast growth factor receptor inhibitors).
Core Tip: Cholangiocarcinomas are very aggressive tumors. Most patients have advanced-stage disease at presentation and the efficacy of systemic therapies for this setting is limited. Albumin bound paclitaxel (nab-paclitaxel) has been approved in some cancers but not in cholangiocarcinoma. We present a clinical case of metastatic cholangiocarcinoma treatment with second-line nab-paclitaxel and we review the preclinical and clinical evidence about its useful in these tumors.