Frontiers in Pharmacology (Oct 2023)

Case report: Remarkable response to sintilimab, lenvatinib, and nab-paclitaxel in postoperative metastatic chemotherapy-resistant combined hepatocellular-cholangiocarcinoma

  • Nan Zhou,
  • Nan Zhou,
  • Chuan-Fen Lei,
  • Chuan-Fen Lei,
  • Si-Rui Tan,
  • Si-Rui Tan,
  • Qi-Yue Huang,
  • Qi-Yue Huang,
  • Shun-Yu Zhang,
  • Shun-Yu Zhang,
  • Zheng-Xin Liang,
  • Hong-Feng Gou,
  • Hong-Feng Gou

DOI
https://doi.org/10.3389/fphar.2023.1190967
Journal volume & issue
Vol. 14

Abstract

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Background: Combined hepatocellular-cholangiocarcinoma (cHCC-CCA) is a highly aggressive malignancy with a poor prognosis. However, there are no consensus treatment guidelines, and decisions are usually extrapolated from intrahepatic cholangiocarcinoma (ICC) or hepatocellular carcinoma (HCC). Given that cHCC-CCA owns the unequivocal presence of both hepatocytic and cholangiocytic differentiation, a combination regimen of anti-PD1 antibody, multikinase inhibitor, and chemotherapy targeting against both components might be an optimal choice.Case presentation: We present the case of a patient with postoperative metastatic chemotherapy-resistant cHCC-CCA who exhibited a durable response and reasonable tolerability to a combination therapy consisting of the anti-PD1 antibody sintilimab, multikinase inhibitor lenvatinib, and nab-paclitaxel, despite having a low tumor mutational burden (TMB-L), microsatellite stability (MSS), and negative programmed cell death 1 ligand 1 (PD-L1).Conclusion: The combination regimen of immune checkpoint inhibitor sintilimab, multikinase inhibitor lenvatinib, and chemotherapy with nab-paclitaxel, which targets both the HCC and ICC components, may represent a promising treatment option for patients with cHCC-CCA. Further research is warranted to validate these findings in larger patient cohorts.

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