Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 16, 2022; 10(32): 11889-11897
Published online Nov 16, 2022. doi: 10.12998/wjcc.v10.i32.11889
Long survival after immunotherapy plus paclitaxel in advanced intrahepatic cholangiocarcinoma: A case report and review of literature
Meng-Ye He, Fei-Fei Yan, Kai-Li Cen, Peng Shen
Meng-Ye He, Fei-Fei Yan, Kai-Li Cen, Peng Shen, Department of Medical Oncology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
Author contributions: He MY, Shen P designed the research study; He MY, Yan FF and Cen KL analyzed the data and wrote the manuscript; All authors have read and approve the final manuscript.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
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: Meng-Ye He, MD, Doctor, Department of Medical oncology, First Affiliated Hospital, Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou 310000, Zhejiang Province, China. 1511051@zju.edu.cn
Received: June 23, 2022
Peer-review started: June 23, 2022
First decision: August 22, 2022
Revised: September 1, 2022
Accepted: October 17, 2022
Article in press: October 17, 2022
Published online: November 16, 2022
Processing time: 137 Days and 19.2 Hours
Abstract
BACKGROUND

Intrahepatic cholangiocarcinoma (iCCA) is the second most common primary hepatic malignancy worldwide. However, currently available systemic therapies are of limited effectiveness, and the median overall survival of patients treated with first-line standard chemotherapy is less than one year. Immune checkpoint inhibitors have been used to treat solid tumors. Clinical studies recently explored the combination of chemotherapy and immunotherapy for CCA. However, the clinical significance of predictive biomarkers for chemo-immunotherapy in CCA remains unclear. It is also worth exploring whether a combination of chemotherapeutic agents can increase the sensitivity of CCA immunotherapy.

CASE SUMMARY

This study reports a case of advanced iCCA in which clinical complete remission had been achieved using a programmed death 1 (PD-1) inhibitor and paclitaxel without known predictive biomarkers, but with BRCA1, KRAS, and NTRK3 mutations after rapid progression to first-line chemotherapy, and has remained in clinical complete remission for more than two years. This case suggests that chemo-immunotherapy is a potential therapeutic option for patients with iCCA and few known predictive biomarkers for immunotherapies as well as synergistic effect of the combination of paclitaxel and PD-1 monoclonal antibody.

CONCLUSION

The combination of paclitaxel and PD-1 monoclonal antibodyr can be explored in patients with advanced iCCA.

Keywords: Intrahepatic cholangiocarcinoma; Programmed cell death protein-1 inhibitor; Paclitaxel; Chemo-immunotherapy; Predictive biomarker; Case report

Core Tip: The first-line standard treatment for advanced intrahepatic cholangiocarcinoma has been programmed cell death ligand 1 antibody combined with gemcitabine + cisplatin therapy, but the median overall survival time still could not break 1 year. However, this patient achieved clinical complete remission after second-line treatment with paclitaxel combined with programmed death 1 antibody and has survived for more than 32 mo. And we performed genetic testing of tissue specimens and found that this patient was without known predictive biomarkers related to immunotherapy efficacy but with BRCA1, KRAS and NTRK3 mutation, and whether there is a therapeutic efficacy correlation deserves further exploration.